Love your Body Yoga Registration Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Which class are you signing up for? (Option to choose more than one class is available)

South Transcona CC - Fall/Winter Series - Nov 6, 13, 20, 27, Dec 4 & 11Bronx CC - Fall/Winter Series - 6pm class Nov 7, 14, 21, 28, Dec 5, Dec 12Bronx CC - Fall/Winter Series - 7:15pm class Nov 7, 14, 21, 28, Dec 5, Dec 12DROP IN South Transcona CC Mondays @7pmDROP IN Bronx CC Tuesdays @6pmDROP IN Bronx CC Tuesdays @7:15pmDROP IN Online Mondays @7pm

Please tell me of any health conditions you may have such as: Heart Disease, Stroke, High or Low Blood Pressure, Dizziness during physical activity, Loss of Consciousness/Fainting for any reason, Concussion, Pain or Swelling in your body caused from an injury or a condition such as Arthritis, Pregnancy, or any other condition or injury that may affect physical activity. Note: I may send you modifications for the Yoga Poses based on your health condition. *

Please note; If any injury or condition happens after filling out this form that may affect your yoga practice please let me know.

Do you require a chair in your practice?*

YesNoUnsure

I agree that by filling out this registration form that I am signing up for the Yoga class(s) as indicated above. I agree to pay the amount indicated (prices listed on the website).*

I agree

I heard about this class through:*

I might be interested in:*

WorkshopsSpeciality ClassesFundraiser ClassesOther

I'd like to learn more about...*

By clicking on "Submit", I agree to the following:

This agreement is between Bernadette Feakes, the additional Fitness Instructors who may be conducting classes as appointed by Bernadette Feakes and the individual whose name is entered in above.

1. I am participating Love your Body Yoga classes offered by Bernadette Feakes. I recognize that all Fitness classes require physical exertion that may be strenuous and may cause physical injury, including death, and I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in Love your Body Yoga classes. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Fitness classes.

3. In consideration of being permitted to participate in the Fitness classes, I agree to assume full responsibility for any risks, injuries or damages (known or unknown), property damage or loss of any kind in which I may incur as a result of participating in the Fitness classes.

4. In further consideration of being permitted to participate in the Fitness classes, I knowingly, voluntarily and expressly waive any claim I may have against the authorized Instructor(s) for any injuries or damages (known or unknown), property damage or loss of any kind, including death that I may sustain as a result of participating in any Fitness classes.

5. This is a legally binding Release, Waiver, Discharge and Covenant Not to Sue (collectively “Release”) the authorized Instructor(s) for any injury, death, property damage or loss of any kind caused by my voluntary participation in any Love your Body Yoga Fitness classes. This Release, Waiver, Discharge and Covenant Not to Sue is made voluntarily by me, the undersigned Releaser, on my own behalf, and on behalf of my heirs, executors, administrators, and legal representatives.

6. I hereby grant Bernadette Feakes permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Bernadette Feakes and will not be returned. I hereby irrevocably authorize Bernadette Feakes to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Love your Body Yoga Fitness programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge Bernadette Feakes from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. (Note: Permission will always be requested before photos are taken)

7. I have read and fully understand the cancellation policy in effect.

8. I have read the above release, waiver of liability and assumption of risk, fully understand its contents and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to be the complete and unconditional release of all liability. I voluntarily agree to the terms and conditions stated above. This agreement remains in effect for as long as I participate in any Love your Body Yoga classes under the instruction of Bernadette Feakes, and other fitness instructors.

Date*

Date

Signature*