Name *

First Name

Last Name

Phone

(###)

###

####

Birthday *

MM

DD

YYYY

For how long?

Less than 6 months

6 months - 1 year

1 - 2 years

More than 2 years

*

I understand and acknowledge the fact 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 at All Life is Yoga and assume all responsibility for all risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the yoga program. I understand that it is my responsibility to consult with my health care practitioner prior to and regarding my participation in yoga classes, By signing below, I release All Life is Yoga, Rutu Chaudhari, all teachers and other students from liability, and hold them harmless for any injury to my person, and damage or loss to my property incurred, 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. If I do not wish to be touched, I will clarify that fact in a signed writing and hand it to the teacher, prior to commencement of class. I understands and agree that photos and videos may be taken during this class for educational and promotional purposes related to All Life is Yoga. Permission is granted to All Life is Yoga to use these materials and release them from any liability related to their use. I understand that compensation will not be received for the use of these materials. I have read, understood and agreed to the policy on this registration form:

Yes

No

*

I understand that by entering my initials in the field below, I am effectively providing my signature, indicating that all the information on this form is true and accurate, to the best of my knowledge.

Yes

No