Name *

First Name

Last Name

Phone *

(###)

###

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Do you have any injuries, prior surgeries, or medical conditions which may impact your ability to participate in this yoga class?

Yes

No

I give consent and choose to participate in the practice of yoga for my own benefit. I assume responsibility to participate in ways that are best for me to get the most out of this practice. I have stated all known medical conditions, and will update the teacher (Lauren) of any changes. I understand yoga is not a substitute for medical treatment. I release the teacher (Lauren) from all liability while practicing yoga with me. (If I have any questions whether this practice is right for me I will consult my healthcare provider prior to class.)

I agree

I disagree