🦋FLOW FOR A CAUSE - RSVP & Waiver Form
Thank you for joining our FLOW FOR A CAUSE yoga class!
This event is dedicated to supporting One City Peterborough.
Please complete this short form to confirm your spot and acknowledge our waiver.  

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Date & Time: Saturday, November 15th - 9:30-10:30am
Location: Mark St. United Church (90 Hunter St. E, Ptbo K9H 1G5)
Class Style: An assisted, gently flow yoga 
Contact us: (905) 429-0178 or rebekkah@energyinmotioncoach.com
Donation List: Hygiene Supplies, Hats, Mittens, Scarves, Ensure/ Boost Shakes, Prepackaged Snacks, Blankets

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  💫 Personal Details
Full Name *
Email Address *
Phone Number (optional, for event updates)  
Emergency Contact Name & Number *
How did you hear about this event? *
  🧘‍♀️ About You
Have you practiced yoga before? *
Do you have any current injuries, medical conditions, or mobility concerns we should know about? (to ensure your practice is safe and supported) *
What inspired you to join this charity event?
  🌺 Waiver & Acknowledgment

By signing below, I acknowledge that:

I am voluntarily participating in this yoga class and understand that yoga involves physical movement which may carry the risk of injury.

I accept full responsibility for my health and well-being during the class.

I will listen to my body and modify as needed.

I release and hold harmless Energy in Motion, the instructor(s), and the venue from any liability for injury or damages that may occur as a result of participation.

I understand this event may include photography and agree that images may be used for promotional purposes unless I opt out below.

 *
Required
  💖 Donation & RSVP Confirmation

I plan to donate:  

Donation List: Hygiene Supplies, Hats, Mittens, Scarves, Ensure/ Boost Shakes, Prepackaged Snacks, Blankets

(please bring clean items in a bag to easily transport to One City 🤓)
 *

Would you like to receive future updates, class schedules, or wellness tips from Energy in Motion?

*
Comments and/or questions
  🌸 Thank You

Thank you for joining us!
We’re so grateful you’re part of this special community event in support of One City Peterborough.

Please plan to arrive a few minutes early — by 9:15 am — so you can sign in, settle onto your mat, and take a few deep breaths before we begin at 9:30 am.

We can’t wait to share this mindful, heart-centered practice with you.
See you on Saturday, November 15th!

With gratitude,
Rebekkah & Jessica
🦋 empowering your health • your well-being • your life

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