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New Student Registration / Waiver Form!

! ! First Name: __________________________ !

Last Name: ___________________________!

Date of Birth (dd/mm/yyyy): ___________________ Email: ____________________________! ! Address: ____________________________________________________________________!

! ____________________________________________________________________________! ! Phone: ____________________________ Alternate Phone: __________________________! ! ! Emergency Contact: _________________________ Relationship: ______________________! ! Emerg. Contact Phone: _______________________! ! ~!

! Level of Experience (beginner, intermediate, expert): __________________________________! ! How did you hear about us? _____________________________________________________! ! What is your main reason for attending Yoga? _______________________________________! ! Can we connect with you on social media, (i.e. Facebook)! or send special events to your email?         ! ! ! !

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Y____ N____!

Physical Risk Assessment!

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Are you currently taking medication, or receiving care! for any medical conditions?     ! ! ! !

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Y____ N_____!

Please List the medication and the health condition! (i.e. Lipitor for Cholesterol): !

! ____________________________________________________________________________! ! Has your Doctor or Health Practitioner given ! you any limits to your physical activity? ! !

! If yes, please explain: ! !

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Y_____  N_____!

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Do you have any recent / old, injuries that may affect your bones, muscles or joints?!

! ____________________________________________________________________________! ! ____________________________________________________________________________! ! Are you currently physically active? What kinds of activities do you do?! ! ____________________________________________________________________________! ! ____________________________________________________________________________!

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! ! Agreement between Teachers and all participants/students (please initial):! ! _____! As a participant, you agree to update your teacher(s) of any ! ! ! ! ! changes to your mental or physical well- being prior to the start of class so that ! ! ! they have the opportunity to modify your activity in the interest of minimizing risk!

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As a participant in class, the student agrees and acknowledges that there is ! ! always a risk of injury. Teachers will do what is in the scope of their knowledge to ! prevent injury and to minimize risk. As a student and participant of the class, it is !! assumed that the student will consult a Doctor prior to starting a physical activity !! and will only do what the student is physically capable of doing, and that the ! ! student is sufficiently self-aware to stop any activity before injury! ! As a participant in class, the student agrees and acknowledges that teachers ! ! may or may not be able to provide the necessary first aid, treatment or diagnosis !! for any injury or illness that may occur, or already be present!

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As a willing participant, Â I understand that most teachers are Independent Business ! Owners who are renting space at this studio. All payments are collected by teachers ! prior to the start of class. Teachers accept cash, cheque, Credit Card and Paypal. You ! may be asked to pay a processing fee for PayPal or Credit Card Processing (approx. ! 3%). Depending on the teacher, you may or may not have to be charged GST. Pre-paid ! punch cards are transferable and are good for one year from date of issue, however ! there are no refunds!

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As a participant in classes or workshops, the teachers, volunteers or sub-!! ! contractors are in no way responsible for the safekeeping of my personal !! ! belongings while I attend class. I understand that classes may be physically ! ! strenuous and I voluntarily participate in them with full knowledge that there is ! ! risk of personal injury, property loss or death. I agree that neither I, my heirs, ! ! assigns or legal representatives will sue or make any other claims of any kind ! ! whatsoever against the studio ,or its renters for any personal injury, property damage/! loss, or wrongful death, whether caused by negligence or otherwise!


_____ The scheduling and content of classes is subject to change without prior notice. Every ! ! effort will be made to update the Schedule on the website, please check often!

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_____ The doors to the studio will be locked during class time. When the class is over, the ! ! doors will be opened and students arriving for the next class are welcome to enter. The ! ! end of class is usually spent in deep relaxation or meditation please be mindful of this ! ! when arriving for your class and keep noise and disruption to a minimum. The class ! ! times will be posted on the door or sandwich board!

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_____ We kindly requests that all participants and guests remove their footwear prior to entering ! the studio and that all persons entering the space treat the equipment and the other ! ! participants and teachers with respect and courtesy. The studio is a SAFE place for all ! ! members of the community regardless of age, gender, race or religion. Please practice ! ! kindness, patience and tolerance!

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By signing below, I acknowledge that I have read the agreement and the information provided by me is accurate and truthful. I am also aware that my information will not be sold or shared with anyone other than the teachers so that they can make every effort to ensure my safety and enjoyment of the classes offered!

! ! ! ! Student Signature:! ! !

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_______________________________________________!

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Guardian Signature! (if student is under 18):!

! ! ! Date:! ! ! ! ! ! Teacher Signature:! ! ! ! ! !

New student registration / waiver form  

jlawYOGI

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