Yoga for High Schoolers

Participant's Name

First NameLast Name

Participant's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Participant's Email

example@example.com

Participant's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age

Date of Birth

Date

If below 18 years old (minor), please enter name of parent or guardian

First NameLast Name

Parent / Guardian Phone

Please enter a valid phone number.Format: (000) 000-0000.

Have you done yoga or any workout program before?

YesNo

If yes, can you please provide more details?

Do you have any physical limitations or any health issues/conditions that we should be aware of?

YesNo

If yes, please provide more details.

Do you have any of the following?

I, First NameLast Name would like to participate in a yoga class being offered at St. John's Episcopal Church. 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. 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 St. John's Episcopal Church and the instructor of this yoga class of any liabilities.I have read and fully understand the terms of the agreement/waiver and accept all of it.

Participant's Signature

Date Signed

Date

Parent/Guardian Name

First NameLast Name

Parent/Guardian's Signature

Date Signed

Date

Yoga for High Schoolers - beginning 9/21

Consent Agreement