New Student Form

Name_________________________________________

Address_______________________________________

City______________________ State___ Zip________

Home phone_________________________________
Work phone__________________________________
E-mail ______________________________________
 *Note: we do not share your personal information

Physical limitations, injuries, etc.__________________
____________________________________________
____________________________________________

In an emergency contact________________________
Contact Phone________________________________

Referral source_______________________________

Referred by__________________________________
Waiver of Liability/Informed Consent

  I, ______________________________________ hereby agree to the following:

  1. That I am participating in the Yoga Classes, Health Programs or Workshops offered by the San Diego Yoga Studio Inc.  during which I will recognize that yoga requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

  2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Classes, Health Programs or Workshops.  I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Yoga Classes, Health Programs or Workshops.

  3. In consideration of being permitted to participate in Yoga Classes, Health Programs or Workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

  4. In further consideration of being permitted to participate in Yoga Classes, Health Programs or Workshops, I knowingly, voluntarily and expressly waive any claim I may have against San Diego Yoga Studio Inc. for injuries or damages that I may sustain as a result of participating in the program.

  5. I, my heirs or legal representatives, forever release waive, discharge and covenant not to sue San Diego Yoga Studio Inc. for any injury or death caused by their negligence or other acts.

I have read the above release and waiver of liability and fully understand its contents.  I voluntarily agree to the terms and conditions stated above.

_________________________________________________________________________
Signature of Participant                                                                                  Date

If participant is under age 18:
As legal guardian of _________________________, I consent to the above terms and conditions:

_________________________________________________________________________
Signature of Parents/Guardian of Participant                                                   Date

Witnessed by: _____________________________________________________________


To register for the Beginner's Course in August, please print this form and mail with $50 check payable to:
San Diego Yoga Studio l 4134 Napier Street l San Diego, CA 92110