Chair Yoga Sign Up Form
Name
*
First Name
Last Name
Age at signup
*
Date
-
Month
-
Day
Year
Date
Phone Number
*
Email Address
*
example@example.com
Please indicate if you have one or more of the following
Arthritis
Osteoporosis
Multiple Sclerosis
Use a wheelchair
Do have you a disability that you would like to bring to my attention, or that you believe may require special adjustments to your Chair Yoga practice?
Do you have any physical limitations such as lower back problems, knees, neck issues such as bulging discs, ankles or anything you believe you would like to bring to my attention?
Do have you an injury, current or past, that you would like to bring to my attention, or that you believe may require special adjustments to your Chair Yoga practice?
By submitting this form I acknowledge that:
I recognise and agree that all exercise, including Chair Yoga, carries certain risks. I recognise and agree that I will use my personal judgement to ensure that I do not unduly strain my body, overextend myself, or move beyond my current capabilities in such a way that may cause personal injury.I agree and acknowledge that by submitting this form I indemnify and hold harmless Adrian Partridge/Urban Health/Our Space for any injury sustained, in any manner whatsoever. While all due consideration for safety will be taken, and adjustments and refinements made for my unique situation, I recognise and agree that I am the sole expert in how much I can do and how far my body can move and I agree not to hold Adrian Partridge/Urban Health/Our Space responsible for any loss or damage to myself or my property.I recognise and agree that I may stop my practice at any time should there be any pain or undue discomfort that will require adjustment, and failure to do so and to bring this to the attention of Adrian Partridge/Urban Health/Our Space is my sole responsibility.
Submit
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