Name *
Name
Date of birth
Date of birth
Phone (best number in case of cancellation) *
Phone (best number in case of cancellation)
Emergency Contact
Emergency Contact
Emergency Contact's Phone
Emergency Contact's Phone
Have you taken yoga before? *
Please include class name, day and time.
What is your curve? Have you had surgery?
Are you a teacher?
Do you mind getting hands-on adjustments as necessary? *
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.
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.
Cancellation Policy *
If you need to withdraw after registering, my policy is as follows. If I receive a written withdrawal on or before September 15th, your payment will be refunded less a $20 administrative fee. If you withdraw after September 15th, provided I can fill your spot, I will refund your payment less a $20 fee. If I am unable to fill your spot your payment will not be refunded!
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.

613B W Morgan St, Raleigh, NC 27603