What is your email address? *

What is your name? *

What is your date of birth? *

I, the undersigned client, understand that the activities involved in these sessions may involve physical, emotional, and psychological activity. In these cases there’s always some risk involved. I understand that I am responsible for assessing the risk that any activity poses to me, and then making safe and empowered choices for myself. *

I, the undersigned client, agree to assume the risk and responsibility for any injuries or damages arising out of my participation in all sessions with Inspired Change Yoga. *

Do you currently have any injuries or concerns? *

I, the undersigned client, I have read and understand the statements above. By joining the class I give consent to be recorded. Please sign your full name here: *

Please print today's date. *