Yoga Questionnaire

This form must be filled in prior to participating in a yoga class.

What benefits are you looking for?
Mark all that apply.
What are your personal yoga interest?
Mark all that apply.
Choose one.
Do any of these health conditions apply to you? *
Mark all that apply.
I represent and warrant that I am in good physical health and do not suffer from any medical condition which would limit my participation in the classes offered at New Horizons Yoga. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any of the yoga classes, programs, or workshops. I understand the risk associated with the activities offered by New Horizons Yoga and agree to follow all instructions so that I may safely participate in classes, workshops, or other activities. I hereby WAIVE AND RELEASE New Horizons Yoga LLC, its owners, officers, employees, and instructors from any claim, demand, cause of action of any kind resulting from or related to my particiapation in the programs offered at the facility. I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, know or unknown, which might occur as a result of my participation in the classes, workshops, or other activities. I have read the above release and waiver of liability and fully understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above. *
I represent and warrant that I am in good physical health and do not suffer from any medical condition which would limit my participation in the classes offered at New Horizons Yoga. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any of the yoga classes, programs, or workshops. I understand the risk associated with the activities offered by New Horizons Yoga and agree to follow all instructions so that I may safely participate in classes, workshops, or other activities. I hereby WAIVE AND RELEASE New Horizons Yoga LLC, its owners, officers, employees, and instructors from any claim, demand, cause of action of any kind resulting from or related to my particiapation in the programs offered at the facility. I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, know or unknown, which might occur as a result of my participation in the classes, workshops, or other activities. I have read the above release and waiver of liability and fully understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above.
Typing your name will constitute as an electronic signature.
Today's Date *
Today's Date