PVWM 2020 Yoga Session Registration
One Gentle Mat Yoga session 2:15-3PM. Chair options will be offered. Reiki will be offered as well. Mats are very limited so please bring one if possible. Wear comfortable clothing that you can move in. Everyone is welcome and included!

Cindy Senk M.Ed Rehabilitation, RYT-200
MOVEMENT FOR ALL

KIRSTEN Benson Perry; Reiki 1 practitioner

REGISTRATION IS LIMITED TO 25 PARTICIPANTS. After 25 participants have registered, all new registrations will be added to a waitlist in case of cancellation.
Email address *
First & Last Name *
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Phone Number *
Your answer
Address *
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Email *
Your answer
I acknowledge and agree that there are risks associated with participating in an Exercise Program offered by or through 180 Fitness ("the Club"). An "Exercise Program" includes (i) using the Facility and participating in Training Sessions, as such terms are defined in the Membership Agreement, to which this Informed Consent and Acknowledgement of Risk is made a part hereof; (ii) strenuous athletic and physical activity; and (iii) recommendations of activity for the improvement of my general health and well-being. THESE RISKS INCLUDE, BUT ARE NOT LIMITED TO, SERIOUS BODY INJURY AND DEATH. *
Required
I acknowledge and agree that not all risks can be known in advance. I acknowledge and agree that, despite these know and unknown risks, my participation in the Exercise Program is entirely voluntary. *
Required
I hereby certify that I have been advised to consult with a physician about my participation in the Exercise Program (i) prior to my participation in any such Exercise Program, and (ii) at any time thereafter if, after starting such Exercise Program, there is any change in my medical condition. *
Required
I further certify that I know of no medical conditions or problems, except those disclosed [on the Health Intake Form], that would increase my risk of illness or injury as a result of participation in the Exercise Program *
Required
I acknowledge and agree that I will immediately notify Club personnel in the event that I experience any illness, injury, discomfort, impairment, or other health problem, including but not limited to fatigue, shortness of breath, chest discomfort, or any other general discomfort, during my participation in the Exercise Program. *
Required
I acknowledge and agree (i) that I have been given the opportunity to ask any questions about my participation in the Exercise Program, and (ii) that any questions so asked have been answered in full to my satisfaction. *
Required
GIVEN THE FOREGOING, I ACKNOWLEDGE AND AGREE THAT I VOLUNTARILY AND WITH FULL KNOWLEDGE OF THE RISKS INVOLVED CONSENT TO PARTICIPATING IN THE EXERCISE PROGRAM. *
Required
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A copy of your responses will be emailed to the address you provided.
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