Registration, Waiver and Release Form
Thank you for registering for a 10-class Mindful Movement package at FireBird Studio!
Please fill out the following form. After you fill out this form, you will be directed to cash payment instructions.
If you have any questions, please email us at info@firebirdstudio.ca or call / text us at (289) 772-6430
First Name *
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Last Name *
Your answer
Postal Code *
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Phone *
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Email *
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Date of Birth *
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Gender *
Are there any specific injuries, ailments or medications the instructor should know about?
If YES, please specify -
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If NO, please check here -
Emergency Contact Information (name & phone) *
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Please type your name to agree to the following: *
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1. That the instruction and services offered by Tara Brasier are limited to that of instruction in basic yoga, meditation and health.
2. That even with clear instruction, there is a possibility of injury, and that it is my responsibility to consult a physician regarding my ability to participate before practicing yoga and meditation with Tara Brasier.
3. I attest that I have no psychological, medical or emotional condition that would prevent me from safe participation in a yoga class, workshop or meditation session.
4. I release and discharge Tara Brasier from any and all liability, claim, demand or action that I may have resulting from injury, death or damages arising from my participation in yoga class, workshop or meditation session, including loss that may be caused by the negligence of the released party.
5. I recognize that the agreement of release and waiver of liability is a legal contract and that, by reading it carefully, I have complete knowledge of its contents.I have read this agreement and fully understand its content and meaning, and sign it of my own free will and I am over the age of 18.
Please enter today's date: *
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Mindful Movement is available Mondays or Thursdays at 6:15pm. Please indicate which day of the week you will be attending class: *
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