Yoga @ DAC ~ New Student Registration

DAC YOGA

New Yoga Student Registration
Date*

MonthDayYear
Date
Birth Date

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
TextCallEmail
Gentle Yoga - Tuesday, 10-11amFoundations Yoga - Wednesday, 9:00-10:00amMidweek Reset 8 Week Series - Wednesday, 3:00-4:00pmOther
Emergency Contact*

First NameLast NameRelationship
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
InjuriesSurgeriesCurrently PregnantBack PainHip/Leg PainArm/Shoulder PainNeck PainKnee PainArthritisHigh/Low Blood PressureHeart ConditionCancerHeadachesFatigueDepression/AnxietyMedicationsAlcohol/DrugsNoneOther
Brief Description of Medical History
Explain the check marks above and list medications. If none write none.
Yoga Experience
What benefits do you hope to gain from yoga? Do you have any concerns or questions? If not new to yoga, please share how long you have been practicing and the style of yoga.
What are your other interests?
Tell us a little bit about yourself.
FriendDowntown Artist CellarMalone TelegramFaceBookInstagramOther
Yes, sign me up!No, thank you!
CHOOSE YOUR CONTRIBUTION

We strive to make yoga accessible for everyone. A sliding scale is offered so everyone can participate in a way that feels comfortable and sustainable.

We strive to make yoga accessible for everyone. A sliding scale is offered so everyone can participate in a way that feels comfortable and sustainable.

Payment may be made in person at the gallery by cash, check, or credit card, or online for your convenience. You are welcome to pay per class or purchase a multi class pass.

Contribution Options

Standard Drop In — $15
5 Class Pass — $65
10 Class Pass — $125

Midweek Reset 8 Week Series - $100

Pay What You Can – for those who need financial flexibility

Pay It Forward – share the gift of yoga
At the GalleryOnline
Signature*

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DAC YOGA