Yoga Registration Information and Waiver Welcome to Awareness Yoga. Please fill out the form completely and inform us of any changes. Please print clearly. ALL INFORMATION WILL BE TREATED AS CONFIDENTIAL. Name Phone E-mail Please indicate by checking this box if you agree to receive information electronically from Awareness Yoga via your email address. You can withdraw your consent at any time by notifying us yes General Background Have you participated in Yoga classes in the past? yesno Which of the following best describes your daily activity level? inactivelightly activevery active Please indicate any physical or health concerns (occurring now or in the past) that your instructor should be aware of. Note any physical injuries or pain. Emergency contact Relationship to Student RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS In consideration of AWARENESS YOGA permitting the individual named below ("I" or "me") to participate in yoga classes at the Awareness Yoga (the “Activities”), and for other good and valuable consideration, I agree to all the terms and conditions set forth in this agreement. I am aware and understand that the Activities involve risks, including but not limited to the risk of physical injury. I acknowledge that I am voluntarily participating in the Activities and understand that I should use caution and only practice to my own comfort level. I will discontinue any exercise that causes pain or discomfort. My Doctor is aware that I am participating in a Yoga program. I am aware and understand that in order to properly teach and correct yoga technique and to prevent injury, physical contact between instructor and student may be necessary. I consent to such contact as is considered necessary by the instructor for the purpose of teaching and correction. Awareness Yoga undertakes to ensure that such contact is applied in a professional manner. I hereby assume all risk of injury or damage to my property during the program of physical activity, or incidental thereto, howsoever and wheresoever occurring. I hereby expressly waive and release Awareness Yoga and its affiliates, employees, agents and representatives from any and all claims and demands or liabilities which I have or may have in the future for any injury to my person or to my property in any way arising out of or incidental to my participation in, or presence during, said Activities. I have read the Policies of Awareness Yoga as outlined and agree to abide by them. Signature Date:
