New Student Registration
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Medical Conditions (Also list any medications you are taking)
Your answer
Injuries
Your answer
Previous yoga experience *
If you have practised yoga before, what style/s have you practised?
Anything else you want me to know?
Your answer
How did you find out about Tracy Gray Yoga? *
Required
Liability Release
I, the participant, acknowledge the following:
- I am engaging in physical activity which may involve some risk of injury
- I have received advice from my physician with respect to any past or
present injury, illness, health concern or medication that may affect my
participation in this physical activity and have clearance to participate.
- I have listed all injuries, medical conditions and medications on this
registration form.
- I understand Tracy Gray and staff have a duty of care to uphold and
that outside of that duty of care, any injuries or loss are my
responsibility. I hereby release Tracy Gray from liability arising from
injury or loss outside of her duty of care.
I have read, understood and agree to the liability release *
Privacy
Your details are kept confidential. Medical information is only collected for the
purpose of sharing with emergency personnel in the case of an emergency.
Your contact details are not shared with anyone outside of Tracy Gray Yoga
and only used for the purpose of correspondence with you.
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