Guru Girls Yoga: Registration and Liability Release Form

Guru Girls Yoga: Registration and Release Form

Please complete and submit this form before participating in the Guru Girls Yoga Program. If you have any questions, contact Margot Brinley at mmbrinley@me.com.
Participant Information
Today's Date

MonthDayYear
Full Name*

First NameLast Name
Grade*
Participant Email Address*
Partipant Cell Phone (if available)

Area CodePhone Number
*

I give permission for Margot Brinley to send Guru Girls program information directly to the above participant via this email address or cell phone.
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Name(s)*
Parent Email Address*
Emergency Contact Name*
Emergency Contact Phone*

Area CodePhone Number
Other Adult Approved for Pick Up: Name
Other Adult Approved for Pick Up: Phone

Area CodePhone Number
Select Guru Girl Yoga Program you will be participating in:*

Participant Questionnaire
Have you ever practiced Yoga before?*

YesNo
Please explain your experience.
What are you hoping to get out of this experience?
Do you have any phyisical concerns that worry you about participating in this program?*

YesNo
If Yes, please explain.
In yoga instructors sometimes physically assist the participants. Please indicate your preference for assistance or no assistance.*

I am okay with assistance.I do not want assistance.
Do you have a pal in the program?

YesNo
If Yes, who?
Please list the extracurricular activities in which you participate.

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Payment Method

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Participant Questionnaire