Liability Release New Student Information First Name* Last Name:* Address* Home Phone*Cell PhoneEmail* Date of Birth MM slash DD slash YYYY How Did You Hear About Us? Medical History: (Please list health conditions, injuries, surgeries) Yoga History (If you are currently practicing yoga, please share how long and what style. If you are new to yoga, what are your interests, concerns or questions?) Emergency Contact (Name, Relationship, Phone #)Name Relationship PhoneSignature (please add your full name) Date MM slash DD slash YYYY If signing on behalf of a minor Participant is under 18 years of age (parent/legal guardian must sign).As Legal Guardian of (name) * I consent to the terms and conditions. I am the parent/guardian of and I am signing this agreement and release on behalf of said minor EmailThis field is for validation purposes and should be left unchanged.
