Yoga Registration

Full Name*
Phone Number*
+1
    Email*
    Please indicate your health condition/s if applicable:
    Arthritis
    Asthma
    Capal Tunnel Syndrome
    Eye problems
    Knee pain
    Spinal Disorders
    Osteoporosis
    High blood pressure
    Low Blood Pressure
    Spondylosis
    Thyroids
    Any Implants
    Any Surgery in the last five years
    Any other health condition/s that are not listed above. Please explain below
    Emergency Name/Phone Number*

    Agreement of Release and Waiver of Liability Form
    1) That I am participating in the Yoga Class/Workshop, offered by Chinmaya Mission Harleysville during which I will receive information and instruction about yoga and health. I recognize that yoga may require some physical exertion, which 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 Class or Workshop. I represent and warrant that I am physically fit and I have no medical condition, which would prevent my full participation in the Yoga Class/Workshop.

    3) In consideration of being permitted to participate in the Yoga Class or Workshop, 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 the Yoga Class/Workshop, I knowingly, voluntarily and expressly waive any claim I may have against Chinmaya Mission Harleysville for any injury or damages that I may sustain as a result of participating in the program.

    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.

    Accept Terms*

    I have read and agree to the above Terms and Conditions.

    Signature (Please Print Name)*
    Date*
    Submit