Student Details Waiver Form

Student Details and Contact Form

* Indicates required field

Name *

First

Last

Upload a photo of yourself if you want to *

Max file size: 20MB

Email *

Phone Number *

Have you practiced yoga before? *

Yes No Not for a long time

What other types exercise or movement do you currently do? *

Specify any limitations, injuries, recent surgeries, or other details that will help me to better support you *

If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day. (Please tick the box to acknowledge that you have read and agree with this statement).(required) *

I understand and agree

I (as named above) understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. By submitting this form, I affirm that a licensed physician has verified my good health and physical condition to participate in yoga classes. In addition, I will notify the teacher of any medical conditions, injuries or physical limitations before each class. I will not perform any postures to the extent of strain or pain. If I am pregnant, become pregnant or I am post-natal or post-surgical, by submitting this form I verify that I have my physician's approval to participate. (Please tick the box to acknowledge that you have read and agree with this statement). *

I understand and agree

I accept that the teacher, Maria Kirsten (Yoga for Grownups), is not liable for any injury, or damages, to person or property, resulting from the taking of the class. (Please tick the box to acknowledge that you have read and agree with this statement).(required) *

I understand and agree

How did you hear about Yoga for Grownups? *

Submit