JNS New Student Registration Form
Last Name *
First Name *
Date of Birth
MM
/
DD
/
YYYY
Address
Phone Number
Only need the best # to reach you at
Email
Do you wish to receive email updates and newsletter from JNS?
Clear selection
How did you hear about JNS Yoga Studio?
Check all that apply
Do you grant JNS Yoga Studio permission to post photos taken on behalf of JNS Yoga Studio in which you may be present on our website or social media site?
Clear selection
Please briefly identify any injuries, illness or conditions your teacher should know about? Eg. High blood pressure, pregnancy, back problems, recent surgery etc.
Please briefly describe previous yoga experience
Name of Emergency Contact
Emergency Contact Phone Number
Are you planning on coming to the Beginners/Fundamentals Classes on Mondays 7:30 - 9:00 PM?
Release Waiver *
I understand that yoga classes and practicing yoga may involve inherent risks, including the risk of physical injury. In consideration of JNS Yoga Studio accepting this registration, I release and hold JNS Yoga Studio harmless from any claim, including a claim for damages, that arise out of an injury to me or damage to or loss of property (incurred at any time and place) while I am: practicing yoga, attending or participating in JNS Yoga Studio classes or workshops, or attending other events or meetings to which this registration applies. Any major concerns about my health or any pertinent medical problems have been discussed with my attending physician and that any imposed restrictions regarding the practice of yoga have been discussed with JNS Yoga Studio. This release is made for myself, for the executor or administrator of my estate, my heirs and assigns. This release applies even when injury, loss or damage has occurred because of negligence by JNS Yoga Studio. In this release, the term “JNS Yoga Studio” means JNS Yoga Studio, 101264903 SASKATCHEWAN LTD., and includes any partner, employee, contractor, teacher, visiting teacher or agent of JNS Yoga Studio. I have read this document carefully. I understand that submitting this document may affect my legal rights, including the right to sue. By submitting this waiver, I acknowledge that I have read the above release and waiver of liability and fully understand its contents and voluntarily agree to all of the terms and conditions.
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.