Nourishing Breath Yoga, LLC Information Sheet and Waiver of Liability form for Online Yoga Classes and Video Recordings of Classes
The following named individual wishes to participate in Online Live Streaming Yoga Classes and/or Video Recordings of Yoga Classes provided by Marcie Leek and/or Nourishing Breath Yoga, LLC.
NAME (first and last name)
ADDRESS (#, street, city, state, zip, country)
Date of Birth (IF YOU ARE UNDER THE AGE OF 18, THIS AGREEMENT MUST BE COMPLETED BY YOUR PARENT OR LEGAL GUARDIAN. PLEASE CONTACT
FOR THE APPROPRIATE FORM).
Person to contact in case of Emergency:
Which class/series are you registering for?
Befriending Your Body through Yoga, Level 1
Befriending Your Body through Yoga, Level 2
Moving through Grief with Yoga
Yoga for Knotted Knitters
Stress Rx Yoga
Befriending Your Body through Yoga: Healthier, Happier Hips
Thursday Evening Stretch
See You Saturday!
Check any area where you have pain, problems, or limitations:
Please list all other physical conditions, limitations, concerns, or injuries
For Women: Are you pregnant, or have you had a child within the past three months?
How did you learn about this class?
Would you like to be added to the Nourishing Breath Yoga mailing list to receive notice about upcoming classes?
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