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Emergency Contact Form
Health Intake Form
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Yoga Therapy Liability Waiver
Date of Birth
Have you been hospitalized in the past 12 months and/or experiencing acute pain?
Please specify anything we should know about your physical and/or mental health and overall well-being.
I declare that the info I’ve provided is accurate & complete and that I am at least 18 years of age and a consenting adult.
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
Select a date
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