CONFIDENTIAL NEW PARTICIPANT INTAKE FORM
Name
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First Name
Last Name
Email
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Please list any physical health issues you live with or are currently dealing with. There are none, just write 'None'
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Please list any any mental health issues you live with or are currently dealing with. There are none, just write 'None'
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Is there anything else you would like to share regarding your participation in this course/training?
DISCLAIMER: By taking classes and By taking classes and using the information shared, you indicate that you 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 you experience any pain or discomfort, you will listen to you body, adjust the posture and cease that class if you experience any pain. You will also continue to breathe smoothly. Yoga, Breathwork and Meditation are not a substitutes for medical attention, examination, diagnosis, mental health assessment & support medical treatment. Yoga and Meditation are not recommended and are not safe under certain medical and mental health conditions. You affirm that you alone are responsible to decide whether to practice Yoga, Breathwork or Meditation. You hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Premajyoti (Karen Butel) and/or Golden Soul Yoga. , you indicate that you 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 you experience any pain or discomfort, you will listen to you body, adjust the posture and cease that class if you experience any pain. You will also continue to breathe smoothly. Yoga, Breathwork and Meditation are not a substitutes for medical attention, examination, diagnosis, mental health assessment & support medical treatment. Yoga and Meditation are not recommended and are not safe under certain medical and mental health conditions. You affirm that you alone are responsible to decide whether to practice Yoga, Breathwork or Meditation. You hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Premajyoti (Karen Butel) and/or Golden Soul Yoga.
Please type your signature to Indicate you agree
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Thank you!