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Yoga 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.
Group classes
Yoga4U - The Yoga & Reiki Studio
Name *
Birthdate *
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DD
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Email *
Address *
Phone number *
Emergency Contact Name *
Emergency Contact Number *
How did you hear about us?
Are you affected by any of the following?
Column 1
Arthritis
Asthma
Neck/Back problems
Shortness of breath
Stroke
High blood pressure
Low blood pressure
Heart condition
Bone/Joint damage
Epilepsy or Seizure
Are you pregnant?
Clear selection
If you ticked any of the above, please provide further details. Please describe in detail any other health or medical condition that you believe may be helpful for your yoga teacher to know: *
Are you currently on medication? If Yes, pls describe. *
Group Class Fees: Etransfer to gpathak13@yahoo.com
Column 1
$60/10 Classes/Month
$80/15 Classes/Month
$90/Unlimited/Month
$50 - (Online)First Month only for New Student
$12 - Drop-in class
Clear selection
Class Start Date *
MM
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DD
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Payment must be in advance : E-transfer to gpathak13@yahoo.com *
Policies:
Payment in advance.
***No refund, No transfer, No hold or extension***

I understand that any activities I undertake, online or in-person, at Yoga4U, located at 13 Bonavista Drive, Brampton L6X 0N2 ON – may require strenuous physical exertion that could cause injury. I am fully aware of the risks involved and understand it is my
responsibility to consult with a physician prior to participation. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns expressly release and forever discharge Yoga4U and the Program Instructors,; and waive any claim against them, their shareholders, officers, directors, successors, heirs or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation.

I have read the above release and waiver of liability, fully understand its contents and voluntarily agree to the terms and conditions stated herein in consideration for those services offered by Yoga4U/Gayatri Pathak.

I declare all of the information provided by me to be correct to my knowledge and have not withheld any information that may result in any consequences.

I agree to advise Gayatri Pathak at Yoga4U in writing if any of the information provided by me changes.

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| gpathak13@yahoo.com | 13 Bonavista Drive, Brampton ON L6X 0N2|
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