Yoga for New Moms with Mariellen - Registration
Fill out this form to pre-register for yoga for new moms (and babies!) with Mariellen VanDyke Brown. Classes are held at Jillian's Drawers in the Ithaca Commons on Mondays from 4:00 - 5:00 p.m.
Email address *
Name (First & Last) *
Your answer
Baby's name:
Your answer
Baby's birth date:
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Phone
Your answer
Address
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Do you or your baby have any health issues? *
Your answer
Did you take prenatal yoga with me?
Have you been released by your doctor to begin light exercise?
How did you hear about this class? (check all that apply)
What are your goals for this class?
Your answer
Waiver & Release
By typing your name below, you agree to the following statements:

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction, and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture, and ask for support from the teacher.

Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against the yoga instructor and the studio where I am practicing.

Signature (type name)
Your answer
Today's date
MM
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YYYY
Looking forward to seeing you & your baby at class!
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