CLIENT INTAKE FORM
Email *
NAME: *
DATE:
MM
/
DD
/
YYYY
ADDRESS:
PHONE: *
Email: *
HEALTH GOALS: *
ANY INJURIES *
WHAT ARE YOUR EXPECTATIONS *
YOGA EXPERIENCE? *
I understand and agree to the following: I am participating in yoga classes during which I will receive information and instruction about yoga and mindfulness, as well as health. I recognize that yoga and mindfulness requires physical exertion, which may be strenuous and may cause physical injury and I am fully aware of the risks. YES- agree NO- don't agree *
Required
I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga and mindfulness classes. YES- agree NO- don't agree *
Required
I agree to assume full responsibility for any risks, injuries or damages, known, or unknown, which I might incur as a result of participating in yoga/mindfulness or any other activities. YES- agree NO- don't agree *
Required
I knowingly and expressly waive any claim I may have against Curly Q Yoga, LLC for injuries or damages that I may sustain as a result of participating in yoga class/bootcamp/private/small group sessions. YES- agree NO- don't agree *
Required
Check for permission for photo release and/or video recording. *
Required
I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. *
Required
NAME( PRINT) in agreement *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy