Client's Name
First Name
Last Name
Client's Phone Number
Please enter a valid phone number.
Client's Email
example@example.com
Client's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
Date of Birth
-
Month
-
Day
Year
Date
Have you done yoga or any workout program before?
Yes
No
Do you have any physical disability or any health issues/conditions that we should be aware of so I can better guide you through your practice?
Yes
No
If yes, please provide more details.
Do you have any of the following?
Lower Back pain
Upper Back pain
Shoulder pain
Numbness to any part of the body
Muscular pain
Neck injury
Seizures
Knee surgeries
Allergies
Surgery
Are you pregnant?
Yes
No
I,
First Name
Last Name
of legal age would like to participate in a yoga class being offered by Yoga Studio. I fully understand that yoga is a physical activity that may or may not cause physical injury. I agree to declare any health issue, conditions I may have before signing up for the program. A physician's recommendation should be provided before the yoga class begins. In the event that poses might be uncomfortable, any suggested modification can be discussed to me directly in a respectful manner. If there's any strain or fatigue, I can come out of the pose to rest and understand that each and every one has its own physical limitations. I fully recognize that any injuries sustained from all the physical activities will be my responsibility. Therefore I release The Spa of any liabilities.I have read and fully understand the terms of the agreement/waiver and accept all of it.
Client Signature
Date Signed
-
Month
-
Day
Year
Date
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