EMMA JAULIN
LIFESTYLE & BALANCE
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PLEASE COMPLETE & SUBMIT BEFORE YOUR FIRST CLASS
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First Name
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Last Name
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Email
Today's Date
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Emergency Contact Name
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Emergency Contact Number
Date of Birth
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Which classes are you attending?
Please describe your yoga practice, including experience and style of classes previously attended.
If prenatal: this your first baby? Please note your due date.
Have you had any complications during your pregnancy or after birth?
Is there anything else you would like us to know?
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Consent of Agreement: • I understand it is my responsibility to consult with a physician prior to and regarding my participation in these yoga classes.
I accept
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I agree to assume full responsibility for any risk, injuries, or damages known or unknown that might occur as a result of the yoga classes at the Health House LTD with Emma Jaulin & cover teachers.
I accept
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• I understand that it is my responsibility to keep the instructor informed of changes in physical abilities, and choose variations of postures that work within my body and strength.
I agree
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• I accept full responsibility for my body & pregnancy & acknowledge that only I am in control of my body and am aware & responsible for all physical risks.
I agree
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• I fully release Emma Jaulin & cover teachers free from any liability, including financial responsibility for injuries, regardless of whether injuries are caused by negligence.
I agree
SUBMIT
PRE & POST NATAL LIABILITY WAIVER
PLEASE COMPLETE UPON BOOKING
FOR CLASSES AT HEALTH HOUSE LTD