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Yoga Class Registration
Wellness and Therapy Classes For Adults and Children
Full Name
Your answer
Age (if kids class child's age)
Your answer
Gender
Email ID
Your answer
Cell Phone
Your answer
Other Phone
Your answer
Address
Your answer
City, State and Zip
Your answer
Health Condition (if any)
Enter NA if no health condition
Your answer
How did you come to know about us?
Check all that apply
Required
If Friend, whom do we thank?
Name and Email ID PLEASE (so we can send compliments to them)
Your answer
Have you Practiced Yoga before? (How Long)
Enter YES/NO and How many YEARS?
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
List all contacts in the order of Priority
Your answer
Class Need
Enter YES/NO and How many YEARS?
Name of the Workshop
If you chose Camp, Retreat, Special Workshop
Your answer
Mailchimp Newsletter Subscription
We send out invitation to join our newsletter. This helps you to be informed of our class schedules, our workshops, retreats and other events. We do not spam you with too many emails. Expect an average of 2 newsletters per month.
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