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CLASS REGISTRATION, WAIVER OF LIABILITY
Please print & fill this page out, take it with you to your first class, and save your self a bit of time on your first visit. We do have mats and props available for your use. Most regular students will eventually purchase their own yoga mat for personal sanitary reasons. That is not a rule, just at this time, we are not selling any props.

WE TAKE CASH & CHECKS ONLY IN THE STUDIO;
WE GLADLY ACCEPT PAY-PALL & DEBIT CARDS ON THE PRICES PAGE

 

Name……………………………………………………………………..Birthday…………………
Address………………………………………………………………………………………………..
City……………………………State…………………………….Zip……………………………….
Phone…………………………………………………………………………………………………..

E-mail (for schedule updates & class cancellations ONLY! Diane (owner/director) is NOT an over-e mailer!

……………………………………………………………………......................................

Please tell us how you heard about NW Community Yoga?....................................................................................

Have you ever taken a yoga class before?……………………………………………………..................................

 I……………………………………………… hereby agree to the following:     

1) That I am participating in yoga, dance or movement classes offered by NW Community Yoga Center or using the Studio for my own movement practice.  I recognize that any physical exertion may be strenuous and may cause injury, and I am full aware of the risks and hazards involved.

  1. I understand that is my responsibility to consult with a physician prior to and regarding my participation in these classes or other movement practice.  I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in these classes.  If I have any existing medical condition, it is explained below.
  2. In consideration of being permitted to participate in these classes or use the studio for my own movement practice, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participation in these activities.
  3. In further consideration of being permitted to participate in these classes or use the studio for my own movement practice, I knowingly, voluntarily and expressly waive any claim I may have against the NW Community Yoga Center for injury or damages that I may sustain as a result of participating in these activities.
  4. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue the NW Community Yoga Center, Studio Owner, and NW Community Yoga Center agents for any injury or death caused by their negligence or other acts.

I have read the above release and waiver of liability and fully understand its contents.  I  voluntarily agree to the terms and conditions stated above.   

 

Signature of Participant:…………………………………………............Date………………………................

Health Restrictions:………………………………………………………………………………………………………

Do you have any history or current problems with high blood pressure, heart disease, diabetes,
dizziness, back or knee problems, or other injuries or surgeries?

Medications:………………………………………………………………………………………………………………..

Are you pregnant:   Y    N    NA

Please let us know if there are any changes in your health.