Yoga Class Waiver and Registration Form

Personal Information

Full Name Date of Birth Email Address Phone Number Address

Emergency Contact

Contact Name Contact Phone Relationship

Health Information

Please list any relevant medical conditions, injuries, or physical limitations Current medications (if any) Allergies

Waiver and Release of Liability

I understand that yoga includes physical movement as well as an opportunity for relaxation, stress reduction and relief of muscular tension. As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. If I experience any discomfort, I will stop the activity and seek assistance. I affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk.

I have read and fully understand the above waiver and release of liability.

Photo/Video Release (Optional)

I consent to the use of photos/videos taken during class for promotional purposes.

Signature Date