Name *

First Name

Last Name

Date of birth

MM

DD

YYYY

Phone (best number in case of cancellation) *

(###)

###

####

Emergency Contact

First Name

Last Name

Emergency Contact's Phone

(###)

###

####

Have you taken yoga before? *

Yes

No

Are you a teacher?

Yes

No

Do you mind getting hands-on adjustments as necessary? *

Yes

No

Acknowledgement and Acceptance of Risk and Responsibility *

In consideration of being allowed to participate in Iyengar Yoga Center of Raleigh yoga classes, by selecting "I agree" the named client acknowledges, appreciates and agrees that: There are risks inherent in the nature of yoga instruction and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant hazard during my participation, I will bring such to the instructor’s attention immediately and/or remove myself from participation.

I agree

In case of injury or damages, I do hereby release and hold harmless Iyengar Yoga Center of Raleigh, its elected and appointed officials and employees, the organizers, sponsor, supervisor or any volunteer connected with the program from any and all claims, injuries, damages, or losses in the program. I assume all risks and hazards of the conduct of the program and release from responsibility any person providing transportation to and from activities. In the absence of signature, payment of fees and participation in the program shall constitute acceptance of the conditions set forth in the release.

I agree

Cancellation Policy *

I understand if I need to withdraw after registering for the workshop that Graham will need a written withdrawal on or before April 14th and that my payment will be refunded less a $25 administrative fee. If I withdraw after April 14th provided Graham can fill my spot, she will refund my payment less a $25 fee. follows. If I receive a written withdrawal on or before September 19th, your payment will be refunded less a $50 administrative fee. If you withdraw after September 19th, provided I can fill your spot, I will refund your payment less a $75 fee. If I am unable to fill your spot your payment will not be refunded!

I agree

Release of Liability *

I, the person named, being above age eighteen, or guardian if a minor, acknowledge and accept full responsibility for my participation in yoga instruction through Iyengar Yoga Center of Raleigh. Choosing "I agree" indicates that I have read this entire document, understand it completely, and agree to be bound by its terms. I am aware that I am giving up important legal rights I might have. I have read this release of reliability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign of my own free will.

I agree