Registration Form - Yoga With Amy

Name

First

Last

Email

Mobile

Date of birth

Q1. Why are you taking a yoga class? Please select as many reasons as you like.

Q2. Do you have any injuries and/or medical condition(s)?

Yes
No

as Why box

Q3. If you answered Yes to Q2, please provide details below. If you answered No, please write n/a in the box

Q4. On a scale of 1 – 10, how physically active are you currently (10 being highly active)?

Score: 1

Q5. How did you hear about Yoga With Amy?

Waiver/Consent Terms & Conditions

By ticking and submitting this form, I accept all terms & conditions. I am participating voluntarily in a class or workshop, in-person or online offered by ‘Yoga with Amy’ and I recognise that yoga requires physical exertion that may be strenuous and cause physical injury, and I am fully aware of the risks and hazards involved. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in yoga classes and I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating. I understand that I may receive physical assists or adjustments to enhance or correct my body posture/alignment during class by the teacher. I will take accountability for alerting the teacher of any injury or impairment in advance before the class begins or if I do not want to receive any assists. I knowingly, voluntarily and expressly waive any claim I may have against ‘Yoga With Amy’ for injury, damages or death that I may sustain as a result of participating in the program. I, my heirs or legal representatives forever release waive, discharge and covenant not to sue for any injury or death caused by their negligence or other acts. If a live class cannot go ahead due to teacher unavailability, a recorded class will be provided online as an alternative. This will count as fulfilment of the class and no refunds or credits will be issued. Photography & Video Recording: In booking and attending a class, the student is consenting to occasional photographs being taken of them in class. These are sometimes taken and used online (website, social media and Google) to support Yoga With Amy’s business marketing. I have read these terms & conditions and release of liability and assumption of risk agreement, fully understand its terms, and agree to it freely and voluntarily without any inducement.