Request edit access
Seniors 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.
Sign in to Google to save your progress. Learn more
Yoga4U - The Yoga & Reiki Studio
Name *
Birthdate *
Email *
Address *
Phone number *
Emergency Contact Name *
Emergency Contact Number *
How did you hear about us?
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: *
Yoga Class Options:
Column 1
Drop-in class $15.00
4 Classes/Month $50
8 Classes/Month $90
Clear selection
Class Start Date *
Payment in advance : E-transfer to *
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.


***No refund, transfer, hold or extension***
***Yoga Mat Rental for $2 per class***

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| | 13 Bonavista Drive, Brampton ON L6X 0N2|
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy