Registration & Release Form SAT Class

First Name *

Last Name *

Date of birth *

Phone *

Email *

Address

Street Address *

City *

State *

Country *

Postal code *

Allergies

Previous Yoga Experience/Other ongoing physical activities

Any other pertinent information (physical and or mental health conditions, new and/ or old injuries, surgeries, goals for your practice)

In Case of Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relation *

Please read the following carefully and sign below.

You are invited to enthusiastically approach your yoga practice. However, use care when determining your own ability to do the exercises offered in these classes. Do not aggravate an existing injury. If you have a doubt as to whether yoga would be recommended for a particular injury or condition, please consult your health professional. The instruction and advice presented in these Kundalini Yoga classes is not meant to be used in lieu of professional medical and/ or psychological care for the treatment of any condition. There are certain limitations to the practice of yoga for pregnancy and menstruation. Please ask Instructor for modifications.

I assume all of the risks normally incidental to the nature of this activity, including risks which are not foreseeable. I, the undersigned, hereby agree to release, indemnify, save and hold the Instructor, Poonam Patel free from any and all liability, actions, causes of action, debts, claims, or demands of any

kind and nature whatsoever which may arise by or in connection with participation in yoga class(es) at Sarva Shakti Yoga.

Signature *

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