Nourishing Breath Yoga, LLC Information Sheet and Waiver of Liability form for Online Yoga Classes
The following named individual wishes to participate in Online Live Streaming Yoga Classes provided by Marcie Leek, Yoga for Knotted Knitters, and/or Nourishing Breath Yoga, LLC.
Email address *
NAME (first and last name) *
Email Address *
ADDRESS (#, street, city, state, zip, country) *
Date of Birth (IF YOU ARE UNDER THE AGE OF 18, THIS AGREEMENT MUST BE COMPLETED BY YOUR PARENT OR LEGAL GUARDIAN. PLEASE CONTACT marcie@nourishingbreathyoga.com FOR THE APPROPRIATE FORM). *
MM
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DD
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YYYY
Person to contact in case of Emergency: *
Check any area where you have pain, problems, or limitations:
Please list all other physical conditions, limitations, concerns, or injuries
Are you physically pregnant, or have you had a child within the past three months?
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How did you learn about this class?
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