Date
*
Enter the start date of the workshop, series class, or event for which you are registering.
MM
DD
YYYY
Name
*
Enter the first and last name of the student attending the session.
First Name
Last Name
Email Address
*
Address
*
Enter student's mailing address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
Enter student's phone number
(###)
###
####
Have you practiced yoga in the past?
*
Please list any health conditions of injuries that the teacher should know of in advance of class
*
Do you have any physical areas of strain e.g. neck, back, knee?
*
How do you hope to benefit from our retreat?
*
How did you hear about our retreat?
Stay in touch with our periodic email newsletters
Emerency Contact Name
*
First Name
Last Name
Phone
*
Please list the phone number the emergency contact can be reached at
(###)
###
####
Liability Release
*
NOTICE: Before participating in this or any exercise program individuals should consult a physician.
VOLUNTARY PARTICIPATION: I, the undersigned, acknowledge that I have voluntarily chosen and request to participate in the yoga class, workshop, event or activity sponsored by Yoga Among Friends.
ACKNOWLEDGEMENT: I am aware that participation in the yoga class, workshop, event or activity may be hazardous. I acknowledge that a certain minimum level of physical health, strength, fitness, and flexibility may be required. I represent that I possess the level of health to participate in these activities. I am voluntarily participating in these activities with knowledge of the risks of injury. I assume all responsibility and liability for any and all injuries I may sustain due to my participation in these activities.
RELEASE: In consideration for being permitted to participate in the yoga class, workshop, event or activity, I agree that I, my heirs, assignees, guardians, and legal representatives will not make any claim against, sue, or attach the property of any of the hosts, instructors, organizers, or participants in the yoga class, workshop, event or activity including but not limited to Yoga Among Friends Inc. for injury or damage resulting from my participation. I release all such hosts, instructors, organizers, and participants, their agents and heirs from any and all actions, causes of action, lawsuits, claims, or demands that I, my assignees, heirs, guardians, and legal representatives, now have or hereafter may have for any and all injury, illness, loss of or damage to property associated with my participation in the yoga class, workshop, event, or activity.
I have carefully read this agreement and fully understand its contents. I have signed this release form freely and voluntarily. I am aware and agree that it is a complete release of liability for any injuries or damages that I may sustain due to yoga classes, workshops, events and activities with Yoga Among Friends and all such hosts, instructors, organizers and participants.
