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Amplify Colectivo Yoga Intake Form
Email address *
Name *
Your answer
Pronouns
Your answer
Address
Your answer
Phone number *
Your answer
Emergency Contact Information (Name, Relationship, & Phone Number) *
Your answer
How did you hear about us? *
Required
Please check if you would like to be added to an email distribution list announcing future yoga classes and workshops. *
Required
Have you practiced yoga before? *
How often do you practice yoga?
What are your goals/expectations for your yoga practice?
Your answer
Please list any medical conditions or current injuries:
Your answer
My signature/submission of this form is binding to this liability waiver from this day forward. *
Required
Please select which yoga class(es) you would like to register for. *
Required
I authorize and request Amplify Colectivo send me an invoice via email through Square for the amount indicated below. *
Required
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