LIFESTYLE & BALANCE
CONNECT WITH ME
PLEASE COMPLETE & SUBMIT BEFORE YOUR FIRST CLASS
Emergency Contact Name
Emergency Contact Number
Date of Birth
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?
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 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 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 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 fully release Emma Jaulin & cover teachers free from any liability, including financial responsibility for injuries, regardless of whether injuries are caused by negligence.
PRE & POST NATAL LIABILITY WAIVER
PLEASE COMPLETE UPON BOOKING
FOR CLASSES AT HEALTH HOUSE LTD