----------------------------------------------------Standard Disclaimer:

In the unlikely event of an accident or injury that occurs during Yoga Class, or in my personal Yoga practice, I will not hold Linda Lyng or the owner, staff members or business organization of the Kimberton Arts Building legally responsible.

Before beginning class, I have consulted with, and been given clearance by my family physician to begin practicing Yoga and do not know of any physical limitation that would prohibit me from safely practicing Yoga. 

By signing this disclaimer, I take full responsibility for my own health and well-being both during class and if I choose to continue to practice Yoga outside of class.

Name (please print):

Signature:

Date: 


----------------------------------------------------Personal Information:

Telephone Number:  (       )                 
Telephone number to be used solely for the purpose of notification of class cancellation for inclement weather or instructor illness.


Email Address: 
Please expect one email every eight weeks notifying you of new sessions.  Your email address may also be used for class cancellation notification in addition to a phone call.

----------------------------------------------------Physical/Medical Conditions:

___Pregnancy     ___ Months pregnant

___Unregulated Hypertension

___Heart Condition (please specify type)

___Spinal Condition/Injury (please give details)

___Motor limitations (please list):

___Other conditions of which you think the instructor should be aware (please elaborate below):