Yoga Registration Form for Irvine

Name

First NameLast Name

Email Address

example@example.com

Phone Number

Format: (000) 000-0000.

Gender

Birthdate (mm/dd/yyyy)

Date

Age Group

Mailing Address

Street Address:

Street Address Line 2

City

Zip Code

Emergency Contact Information

Name

First NameLast Name

Phone

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

Media Consent

I grant permission to Saahas for Cause organization, the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Saahas for Cause and its legal representatives from all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

I acknowledge that I am over the age of 18.

COLLECTION, USE, & DISCLOSURE OF PERSONAL INFORMATION

We do not disclose your personal information to other organizations or individuals except as required to fulfill the purpose(s) of the program or service and only to the extent required or authorized by law. Some functions within these programs or services are provided by service providers external to the departments All external service providers that provide you with services on our behalf must comply with our privacy requirements and must meet the applicable security, privacy and terms of use provisions.

Saahas For Cause – Yoga Liability Waiver

I understand that participating in yoga involves physical activity and carries a risk of injury. I confirm that I am voluntarily participating in yoga sessions offered by Saahas for Cause and am physically able to do so,or have consulted a healthcare professional.

I acknowledge that Saahas For Cause, its directors, officers, employees, volunteers, and instructors are not medical providers and that yoga is not a substitute for medical care. I agree to monitor my condition and stop any activity that causes pain or discomfort.

To the fullest extent permitted by law, I release and waive and discharge any claims against Saahas For Cause and its representatives for injuries or damages arising from my participation.

I acknowledge that I have read and understand the above information regarding the collection, use, and disclosure of my personal information.

Date