Welcome to Village Yoga
This is our Liability Waiver and Emergency Contact form. It is MANDATORY that each and every student fills it out and acknowledges their signature at the bottom. Thank You, Merrily & MJ McDonald
**** This information is for the SOLE USE of Village Yoga, LLC ***
Email address *
Your First Name *
Your answer
Your Last Name *
Your answer
WAIVER
I acknowledge and agree to the Waiver above by checking "Acknowledgment" Below. *
Required
Your Cell Phone # *
Your answer
Zip Code *
Your answer
Birth Date *
MM
/
DD
/
YYYY
How did you hear about us?
Have you seen Village Yoga on...
In case of a Minor (under 18 years of age), Your First & Last Name
Your answer
I acknowledge and agree to the Waiver above by checking "Acknowledgment" Below in the case of a Minor.
Emergency Contact *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone # *
Your answer
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