Yoga Registration and Intake Form
Please complete this form to register for yoga classes and provide important health and contact information.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Do you have any injuries, medical conditions, or physical limitations we should be aware of? If yes, please describe.
Are you currently pregnant?
Yes
No
Have you practiced yoga before?
*
Yes, regularly
Yes, occasionally
No, I am new to yoga
What are your goals or expectations for joining the yoga class?
Please read the following and ask if you have any questions. I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all physical, mental or emotional effects our outcomes which may incur through my participation in yoga classes. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By participating in yoga classes or sessions I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have in the future from my my particpation in yoga classes or sessions at Luminous Soul Center for Well Being under any instructor. I have read and fully understand and agree to the above terms of this Agreement and Release of Waiver of Liability.
Signature of Participant
*
Date of Signature
*
-
Month
-
Day
Year
Date
How did you hear about our yoga classes?
Please Select
Friend or family
Social media
Website
Flyer or poster
Other
Register
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