REGISTRATION FORM

Yoga In Daily Life of Greater Atlanta, Georgia

First Name: 

Last Name: 

Address: 

City: 

State: 

Zip: 

Phone (H): 

Phone (W): 

Class registering for:

To be able to participate in our classes, you have to sign the Waiver of Responsibility:

I understand that the level of my participation in this exercise program and which exercises I perform must be determined by me, in consultation with my physician, and that the instructor cannot fully monitor the extent of my participation.

I understand that the instructor is not a physician, nurse or emergency medical technician, and that the instructor by making this exercise program available, is not undertaking any responsibility regarding my medical condition(s). If my medical condition should change, I understand that it is my responsibility to discontinue the exercise program and to immediately consult with my physician about continuing or resuming participation in this program.

I hereby release, indemnify and hold harmless the instructor(s) of this exercise program from any and all claims, demands, personal injuries, costs or expenses, arising out of my participation in this program.

I understand the nature and extent of the exercises in which I am participating and that, while performing those exercises, I could sustain bodily injury. I am nevertheless voluntarily agreeing to participate in the exercise program and perform those exercises conducted by the instructor.

I understand that I would not be accepted in this program without the execution of this Release. I have read this Release and been given the opportunity to ask any questions. I have received and understand the information which was provided.

Participant or Legal Guardian Signature____________________________________________

Date________________________________

 

Please, print the filled out form, sign and mail it with your check or money order to:

Yoga In Daily Life

4131-B Hamilton Mill Rd.

Buford, GA 30519