Name

First Last

Date

Address

Street Address Address Line 2 City State ZIP Code

Email

Emergency Contact

Phone

Have you ever participated in yoga?

Yes
No

If yes, when and how often

Do you have any medical restrictions?

Yes
No

If yes, please explain

What are you looking for from yoga?

Would you like to be included in communications?

Yes
No

Yoga Activity Disclaimer

I hereby consent as a participant in Starr’s Align Yoga and HOLY YOGA classes and am free to assume all the of the risks involved. I understand that Starr’s Align Yoga and the HOLY YOGA program does not provide insurance relative to accidents, injuries, and/or death as a result of program related activities; and that one cannot hold HOLY YOGA or affiliated HOLY YOGA teachers personally responsible for any liability

I hereby affirm myself to be physically sound and suffering no condition, aliment or impairment, disease, or other illness that would prevent my participation in Starr’s Align Yoga classes/HOLY YOGA activities. I declare that I have disclosed any and all medical history to Starr’s Align Yoga and/or their affiliate relevant to participation. I hereby affirm that I am voluntarily participating in these activities with the knowledge of the risk involved. I agree to expressly assume and accept any and all risks of injury and/or death.

CDC Guidelines

In accordance with the CDC guidelines please stay home if you have a fever, are not feeling well, or have been with someone who is sick within the last 14 days. Please enter and exit the studio with a mask on.

Intake Form

Yoga Activity Disclaimer

CDC Guidelines