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
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?
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?
If Yes, please explain.
In yoga instructors sometimes physically assist the participants. Please indicate your preference for assistance or no assistance.
Do you have a pal in the program?
If Yes, who?
Please list the extracurricular activities in which you participate.

Payment Method
Credit	Express

Participant Questionnaire