Stouffville Yoga Life
**Please note, all of the information on this form is kept confidential.
City: _________________________ Prov:______________ Postal Code:_________________
EMERGENCY CONTACT: __________________________________________________________
EMERGENCY CONTACT PHONE NUMBER: ___________________________________________
Have you practiced yoga/pilates before? YES/NO (Please circle)
If YES, for how long? ______________________________________________________________
If at any time during the class, you feel discomfort or strain, gently come out of the posture or exercise. You may rest at any time during the class. It is important in yoga/pilates that you listen to your body, and respect its limits on any given day.
I, the undersigned, understand that yoga/pilates is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga and pilates. I recognize that it is my responsibility to notify my teacher of any physical condition that may affect my abilities before every class. I will not perform any postures or exercises to the extent of strain or pain.
I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class. Those under 18 years of age must have this form signed by a parent or guardian.
___________________________ __________________________ ______________
Name (Print) Signature Date
__________________________ __________________________ _______________
Parent/Guardian Signature Date