Yoga Happens Here Waiver

YOGA HAPPENS HERE

Class Registration & Health Waiver / Release Form
SECURE SITE CONNECTION

Your information is private and secure when using this form.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com
Birthdate*

MonthDayYear
Date
Age
Sex*

MaleFemale

Do you have now, or have you had within the past year...*

	YES	NO
History of Heart Problems?
High Blood Pressure?
Muscle, joint or back disorder that could be aggravated by physical activity?
Surgery?
Diabetes?
High blood cholesterol?
Asthma?
Osteoporosis?
Do you smoke?
Are you presently taking any medications?
Are you now, or have you been pregnant within the last three months?
Allergic/sensitive to fragrances?

If you answered YES to any of the above (except smoking), do you have your doctor's permission to exercise?

YESNO
REGULAR CLASS SCHEDULE: Which classes would you like to take?

TUESDAY: Relaxed & Retired - 10:30 AMWEDNESDAY: Balanced Self - 10:30 AMFRIDAY: Beginners Yoga - 10:15 AMFRIDAY: Chair Yoga - 12:00 PMSATURDAY: Coffee Express - 8:30 AM
Would you like to take this class via Zoom? (NOTE: Not for first time students!)*

NO - I prefer in-studio classYES - Send me a Zoom Link

Purchase a single class or SAVE with a multi-class bundle. Classes good for 3 months after purchase:*

Pop Ups -$10.00

Coffee Express Drop In -$12.00

Coffee Express 5 Classes at $11 per class -$55.00

Single Class - $15.00

5 Classes at $14 per class - $70.00

10 Classes at $13 per class - $130.00

Total $0.00

I have truthfully and honestly disclosed all medial issues I have above. I waive any possibility of personal damage and waive any liability against Paula Bayer and Yoga Happens Here which may be blamed on such an exercise-yoga program and accept full responsibility for requesting such exercise and instruction. I voluntarily assume complete responsibility for my health and well-being in the voluntary yoga program or class and understand that no responsibility is assumed by Paula Bayer and Yoga Happens Here.

I am also ok with photos/video that may contain my image to be used in marketing material on websites and/or Facebook for promoting Yoga Happens Here.

* As a reminder, out of respect for our students/staff that have allergies to such, please limit the use of fragrance such as perfume or cologne while attending a class. Thank you!
*

By checking this box, I agree to the above statement.
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YOGA HAPPENS HERE