Family Yoga Registration Form

	Guiding You on Your Journey to Health and Balance Through Yoga	1616 E Battleground Ave Greensboro, NC 27408 (336)272-0005


Registration Form	Date: _____________

First Name: ________________ M: __ Last Name: __________________

Address: __________________________________________________

City: ______________________________ State: _____ Zip: __________

Home Phone: (____) ____________ (Work/Cell): (____) ______________

E-mail: ____________________________________________________

Learned About Family Yoga from:

__________________________________________________________

I agree to limit my participation in yoga classes to the level of activity
that is comfortable to my physical situation at the time.

I understand that I am waiving Family Yoga and instructors from any
and all liabilities by participation in yoga classes.

Signature: ________________________________
(Parent/Guardian if under 18)

* IF APPLICABLE:

Physician / Midwife / Caregiver’s Approval

_______________________________________ (Student Name)
has my consent to participate in Prenatal / Postnatal yoga classes.


Sign: ______________________________	Date: ___________

Please print, fill out and bring with you to class or

Mail to:	Family Yoga
	P.O.Box 534
	Summerfield, NC 27358