2019 Yoga Enrolment Form

Name *

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Next of Kin*

First NameLast Name

Next of Kin phone number*

Area CodePhone 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.

YesNo

My Products

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

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

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

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

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

Total $0.00AUD