Satyananda Yoga Center

Registration Form

Contact information:
First name:
Last name:
Email address:  Telephone / Cell Phone:
Age: Profession:
Mailing address:  * required Please list any physical or mental impairment, recent surgeries, illnesses, aiments such as high blood pressure, diabetes, heart conditions, etc.	Request information on:
Liability Waiver:	I have been examined by a licensed physician within the past six months and have been found by such physician to be in good physical health and fully able to perform all yoga excercises which I am to learn during my enrollment with you. I will follow faithfully all instructions given me by you and your instructors. I will participate not beyond my abilities and rest as needed. I understand that none of the Satyananda Yoga Center or Y.E.S. (Yoga Education in Schools) instructors have or will render any medical services to me, including medical diagnosis. I am aware that participation in yoga may result in accident or injury, and I assume all the risks in any way associated with my participation in the yoga class. I agree that neither Satyananda Yoga nor any of its owners, officers, instructors, teachers, educators, yoga acharyas (masters), employees or agents shall be liable for any claim, demand, cause of action of any kind or injuries resulting in whole or in part from my use of the Satyananda Yoga facilities or participation in the yoga class, and I agree to hold Satyananda Yoga Center, Austin harmless from same. I agree that should my child/children cause any property damage or hurt or harm another child or children or adult or adults I shall bear responsibility and pay for the cost of this damage or harm to himself or herself or to another person/s or property/properties. I assume full responsibility and liability for my child/children's actions, behavior or words. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to these terms and conditions. Date_____________ Signature__________________________ Referred by________________________
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