New student information form

New student form

1. Name(required)
2. Address (city, state, Zip code)(required)
3. Phone (home)(required)
4. Phone (cell)(required)
5. E-mail address(required)
6. Date of birth (mm/dd/yyyy)(required)
7. Previous yoga experience(required)
8. Other forms of regular exercise(required)
9. Physical problems or areas of concern(required)
10. Are you under any form of treatment for anything? If so, what condition and treatment?(required)
11. What attracted you to yoga?(required)
12. What are your goals in studying yoga?(required)
13. How did you hear about this studio?(required)
14. I agree to take full responsibility for not exceeding my limits in the study and practice of yoga and for any injury or discomfort I might experience in the study and practice of yoga.
15. It is my responsibility to ascertain that there is no medical reason why I should not study and practice yoga.
16. I waive any claim that I might have at any time for injury of any sort against the Raleigh Yoga Center and any instructors at the Raleigh Yoga Center or entity involved therewith.
17. I agree to the above policies. Signed:(required)