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) *
Email Address *
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 marcie@nourishingbreathyoga.com FOR THE APPROPRIATE FORM). *
MM
/
DD
/
YYYY
Phone number: *
Person to contact in case of Emergency: *
Which class/series are you registering for? *
Required
Check any area where you have pain, problems, or limitations:
Please list all other physical conditions, limitations, concerns, or injuries
Are you physically pregnant, or have you had a child within the past three months?
Clear selection
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?
Clear selection
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