Strength In Om New Student Form

Name *
Phone *
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number
Liability Waiver *
As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga practice and/or specific poses are not recommended for individuals with 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. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant, am post-natal or post-surgical, my signature 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 WAIVE AND RELEASE Strength In Om, its owners, employees, and instructors from any claim, demand, cause of action of any kind resulting from or related to my participation in the programs offered at the facility. In taking part in the yoga classes, workshops, or other activities through Strength In Om, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, known or unknown, which might occur as a result of my participation. I grant permission to Strength In Om and its representatives the rights to my photographed image at this event. I understand that my image may be published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. I understand that I will be added to the Strength In Om e-mail list. I have read the above release and waiver of liability and fully understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above. By selecting the checkbox below, you are signing this agreement electronically. You agree your electronic signature is the equivalent of your manual signature on this Agreement.
What type of classes would you like to see in the future from Strength In Om? (Check All That Apply) *