Student Registration

Atha Yoga Grass Valley Student Registration & Liability Agreement

Name (required)

Phone (required)

Email (required)

How did you hear about us? (required)

Address (required)
City (required)
State (required)
Postal code (required)

Are you new to Yoga? (required)
Yes. I'm new to Yoga.No. I have Yoga experience.

Are you new to Ashtanga Yoga?
YesNo
Are you new to the Mysore method?
YesNo

Do you have any injuries, conditions, or limitations we should know about? (required) NoYes

Please summarize any injuries, conditions, or limitations you have. (required)

Who should we contact if there is an emergency (required)

Emergency contact phone (required)

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I am a participating student of yoga at Atha Yoga in Grass Valley ,California. All classes, virtual or in person are taught by authorized teacher Devorah Sacks

I am aware that yoga requires physical exertion that could, if practiced incorrectly, cause physical injury, and I am aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in these classes.

I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in these classes.

I agree to hold Atha Yoga and Devorah Sacks harmless from the same. I specifically agree that Devorah Sacks and Atha Yoga shall not be held liable for any claim, demand, cause of action of any kind whatsoever for, or on account of death, personal injury, property damage or loss of any kind resulting from or related to my use of the class facilities, or my participation in any physical exercise, yoga, or activity within or without the class premises.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

I have read the AGREEMENT OF RELEASE AND WAIVER OF LIABILITY above. I understand it and agree to its terms.

Date of signing (required)

Signature: