FOR PARTICIPATION IN YOGA CLASSES AT YOGA PRANA

Date:___________________________ 

Name:_________________________________________________________________

Address:__________________________________________________________________________

Phone:   _________________________

City: ________________________________St. _______ Zip: ___________

Cell Phone : __________________________________

Occupation: ________________________________________________

Email:  _______________________________________________________

Birthdate: ____________________  

Emergency Contact:  ________________________________________________

1) Have you practiced yoga before? ______ How long? ______

What style?  _______________________________

2) To help us provide you with proper guidance, please list any physical limitations that may affect your yoga practice.  

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Please read the following AGREEMENT OF RELEASE and WAIVER OF LIABILITY carefully before signing:

I understand and acknowledge that in yoga, as in other forms of exercise, sports, bodywork, or self-development, there exist certain inherent risks. I voluntarily participate in the yoga instruction taught at YOGA PRANA and agree to assume full responsibility for all risks, injuries or damages known or unknown, which might incur as a result of participating in the yoga program offered.

I understand that it is my responsibility to consult with my health care practitioner prior to and regarding my participation in yoga classes, workshops or other programs offered at YOGA PRANA. By signing below, I release YOGA PRANA, it’s owner and instructors, as well as KCRA Colorado Place, LLC (landlord), other students and individual substitute teachers from liability, and hold them harmless for any injury to my person, and damage to my property while on the premises at 2580 Highway 95, Suite 217, Bullhead City, AZ 86442, whether caused in or out of class, by negligence or otherwise. I know that yoga requires alignment of the body and that yoga teachers often adjust students to help them get the poses more accurately. By signing below, I consent to such touch and adjustment.

I realize that just as students choose their teachers, teachers choose their students, and that some teachers may choose not to accept me as a student and I agree to abide by the teacher’s choice in the matter.

I acknowledge and accept that all class fees, once paid, are not refundable.

Signature______________________________________________________________________

Date__________________________________

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