Spice Harmony New Student Form
Brand new to our studio? Pay $90EC at your first class to get 1 month unlimited yoga!

Please note that all of your information is kept strictly confidential.
www.spiceharmony.org

About You
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Email *
Write "none" if you do not have an email address
Your answer
Phone Num. 1 *
Your answer
Phone Num. 2
Your answer
Occupation:
Your answer
Birthday: *
MM
/
DD
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YYYY
Have you practiced yoga before? *
How did you find out about our classes? *
Your answer
Emergency Contact
Name *
Your answer
Phone Num. 1 *
Your answer
Phone Num. 2 *
Your answer
Relationship *
Your answer
Additional Information
Do you participate in other physical activities? If so, which? *
Your answer
Please describe any health-related conditions that you have (or have had in the past) that conceivably could affect your yoga practice *
eg. bone, muscle, ligament, tendon problems or injury; heart, lung, high blood pressure, back or neck pain, back or neck injury, epileptic, diabetic or thyroid conditions,pregnancy.
Your answer
Are you currently on any medications? *
If yes, please indicate what condition(s) you are being treated for.
Your answer
Please describe any side effects of these medications that you experience that may impact your yoga practice.
eg. change of heart rate, lack of coordination, etc.
Your answer
Additional notes:
Is there anything else you think we should know to create the best experience for you in class/workshops.
Your answer
Our Agreement
If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day.
I understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will not perform any postures to the extent of strain or pain. I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class.
Guardian giving consent for participant under 21:
Please type full name.
Your answer
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