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Registration & Disclaimer Form
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
Full Name *
Gender *
Birthdate *
Email *
Address *
Phone number *
Emergency Contact Name *
Emergency Contact Number *
How did you hear about us?
Have you practiced Yoga before?
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Are you currently involved in a regular fitness program?
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What do you wish to learn or achieve from your Yoga/Meditation practice at Yoga4U? *
Do you have any injuries or recent surgeries that may restrict your yoga practice? *
Are you pregnant or have you given birth in the last six months?
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Are you currently on medication? If Yes, pls describe. *
Please describe in detail any other health or medical condition that you believe may be helpful for your yoga teacher to know: *
Advance Pmt via E-transfer to
Column 1
$40/Class One on one private class
$360/10 classes (10% Discount)
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Class Start Date *
Payment: Cash/E-transfer in Advance *
Disclaimer & Cancelation policy:
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 24 hours’ notice is required if cancelling or changing a session.
Any cancellations with less than 24 hours notice will be charged the full amount for the private 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.

You will need your own yoga mat, towel, a bottle of water and most importantly a positive attitude.

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: *
| Yoga4U |Gayatri Pathak|647-628-8241| | 13 Bonavista Drive, Brampton ON L6X 0N2|
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