Liability Release

X/Twitter
This field is for validation purposes and should be left unchanged.
First Name*
Last Name:*
Address*
Home Phone*
Cell Phone
Email*
Date of Birth
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
Phone
Signature (please add your full name)
Date
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