2019 Yoga Enrolment Form

Stress-Less Health

Monday & Thursday Baldivis Participant Registration Form
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *
Next of Kin *

First Name Last Name
Next of Kin phone number *

Area Code Phone Number
Injuries/medical history (state nil if none): *
Any other information:
Liability Waiver (please check box) *

Classes are non-refundable and non-transferable. I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now, or hereafter may have, against Karen Holden-Rankine and/or Stress-Less Health
I agree to allow any photographs taken during classes which contain my image to be used by Karen Holden-Rankine and Stress-Less Health in any future advertising/promotions.

Yes No
My Products

Monday & Thursday Term Pass ($16 per class) $ 192.00 AUD

Monday PM Yoga Term Pass ($18 per class) $ 108.00 AUD

Monday PM Yoga 5-Class Pass ($20 per class) $ 100.00 AUD

Thursday PM Yoga Term Pass ($18 per class) $ 108.00 AUD

Thursday PM Yoga 5-Class Pass ($20 per class) $ 100.00 AUD

Total $ 0.00 AUD
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Stress-Less Health