Breath + Cadence Yoga Registration Form

Name *

First

Last

Email *

Phone Number *

Date of Birth

Address

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Any current/previous injuries? *

If below 18 yrs (minor) please enter name of parent or guardian

First

Last

Parent/Guardian Phone Number

Have you done yoga or any workout program before? *

Yes
No

Do you have any physical disability or any health issues/conditions that we should be aware of? *

Yes
No

If yes, please use the space below to describe

Do you have any of the following?

Are you pregnant?

Yes
No

Choose an Option:

After completing and submitting the form, e-transfer payment instructions will be sent, and a Zoom link will be sent once payment is received. Registration closes 15 min before each class.

Terms of Service *

I accept the terms of service below

I would like to participate in a yoga class being offered by Breath + Cadence. I understand that not all exercises are suitable for everyone, and everyone has their own physical limitations. I fully understand that I am participating in an online class at my own risk, and the risks of injury from online classes are possible. I accept and consent to reasonable verbal adjustments as given by the instructor when considered necessary, and I agree to mindfully follow instructions and immediately stop any activity that causes pain, unreasonable discomfort, or emotional distress. In the event that a pose is uncomfortable, I understand I can ask for modification and it will be discussed with me directly in a respectful manner. If there’s any strain or fatigue, I can come out of the pose to rest at any time.

I understand the instructions and advice given are not medical advice and should not be used as such. I fully recognize that any injuries sustained from all the physical activities will be my responsibility and I release the instructor and Breath + Cadence of any liabilities, loss, or injury in connection with these exercises. I have read and fully understand the terms of this release of liability and I fully understand that yoga is a physical activity that may or may not cause physical injury. Guidance, rules, equipment, and personal boundaries may reduce these risks, but risk of injury and illness do exist.

I have permission from my doctor to participate in moderate to vigorous exercise, and I agree to declare any physical, or psychological health issue that may affect my ability to participate (past or present) before signing up for the program. I fully recognize that any injuries sustained from these physical activities will be my responsibility.