Private Yoga Intake Form

Hi there! I'm so excited you have decided to take the next steps towards a better and healthier you! Please take a few moments to fill out the information below. I look forward to working with you! xo Vanessa Michele

 

Name *
Name
Phone *
Phone
Address *
Address
Yoga Goals *
Are you pregnant? *
Name
Name
Phone
Phone
As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga practice and/or specific poses are not recommended for individuals with certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant, am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby WAIVE AND RELEASE Vanessa Thomas from any claim, demand, cause of action of any kind resulting from or related to my participation in the programs offered at the facility. In taking part in the yoga classes, workshops, or other activities organized by Vanessa Thomas, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, known or unknown, which might occur as a result of my participation. I have read and fully understand and agree to the above release and waiver of liability. I am legally competent to sign and voluntarily agree to the terms and conditions stated above. By typing your name in the box below and selecting the checkbox below, you are signing this agreement electronically. You agree your electronic signature is the equivalent of your manual signature on this Agreement.
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