Registration & Waiver Form

Current students - please complete this form and submit before 31st January 2019.

New students - please complete this form and submit before your first yoga class.

The information supplied by you on this form will be treated as strictly confidential. Please ensure that your information is complete and accurate.

If you have any questions please email, call or text Nicky: nicky@flourishmindfully.com.au and 0422 502 423.


Name *
Name
Briefly outline any specific injuries, ailments, medical conditions or medications that your instructor should know about?
Release & Waiver *
If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day. I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation. I understand that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program, if required. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signing verifies that I have my physician’s approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Nicky Angelone and all related facilities and premises for any personal injury or negligence.
Please type your full, legal name below to serve as a digital signature as release of liability and a waiver of the right to sue if any loss results from your participation in our yoga classes.
Email correspondence *