Prenatal Yoga Registration & Disclaimer Form

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Your information is kept confidential and used only for the purposes of understanding your needs as an individual and to reach you in the event of class changes or cancellations.

Yoga4U - The Yoga & Reiki Studio

Name *

Birthdate *

YYYY

Email *

Address *

Phone number *

Emergency Contact Name *

Emergency Contact Number *

OB/GYN or Other Health Care Professional: *

Phone Number (Health Care Info) *

Due Date: *

YYYY

How did you hear about us? *

Are you new to yoga? *

Have you practiced yoga since you’ve been pregnant? *

What are your main reasons for taking yoga classes?

Column 1

To increase flexibility

To improve muscle strength

To increase energy

To reduce muscle tension in neck, shoulders

To reduce muscle tension in lower back

To reduce feelings of stress/increase peace of mind

To improve breathing/learn new breathing techniques

To improve balance/coordination/stamina

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Do you currently have any injuries or physical limitations in addition to pregnancy? Please describe. *

Please describe in detail any other health or medical condition that you believe may be helpful for your yoga teacher to know: *

Prenatal Yoga Class Monthly Packages (E-transfer to gpathak13@yahoo.com):

Column 1

165/15 Classes in a month

$155/12 Classes in a month

$120/8 Classes in a month

$90/5 Classes

Drop-in $22/Class

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Class Start Date *

YYYY

Payment: E-transfer to gpathak13@yahoo.com *

Disclaimer:

I acknowledge that it is my duty to exercise ordinary care for the protection of others and myself while attending yoga class or other classes at Yoga4U. I assume the risk of physical activity with my own physical condition. I have received advice from my doctor that I am capable of physical exercise such as provided by Yoga4U, or I will seek such advice, or I will assume the risk of exercising without a doctor’s examination. This form continues to be effective as long as I am taking classes at Yoga4U or from its instructors in Yoga4U or other locations.
I take complete responsibility for my presence at the Yoga4U and I will not hold Gayatri Pathak or any other instructors or Yoga4U responsible for any injuries or loss I may incur as a result of my participation in any yoga classes or other classes and for any time I am taking classes.
I understand that a minimum 1 hour’ notice is required if cancelling or changing a session.
Any cancellations with less than 1 hour notice will be charged the full amount for the class.
Class can be rescheduled before the end of the last class purchased.
***No refunds for cancelations***
Should the teacher have to cancel due to illness, the session will be rescheduled to a time to suit all parties.
$2 for Yoga Mat Rental.

I hereby confirm that I have read and fully understand this release of liability and assumption of risk agreement, fully understand its terms, and sign it freely and voluntarily without inducement.

Signature & Date: *

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