quickfityoga registration form

Name:

Address:

Postcode

Home Phone:

Fax Number:

E-mail Address:

Work Phone:

Mobile Number:

Birthday:

Have you done yoga before?

Yes

No

If yes, what kind?

How fit do you consider yourself to be now?

1 = unfit, 5 = very fit
1 2 3 4 5

What is your main reason for coming? (Tick as many as you wish)

To supplement my training/exercise

To lose weight

To begin exercising

To increase my lung capacity

To tone my body

To increase joint mobility

Get strong and flexible

To have time for myself

To increase my concentration / focus

Other

What conditions would it be better that we are made aware of?
(medical or physical, sore neck or lower spine, reconstructed knee...)

What medication, if any, are you taking?

Are you a smoker?

Yes

No

How did you hear about us?
(friend's name, advertisement, letterbox flyer, web-site)

In consideration of and as an inducement to you enrolling me as a student of quickfityoga I represent and agree as follows:

1. I have been examined by a licensed physician within the past six months and have been found by such physician to be in good physical health and fully able to perform all Yoga exercises which I am to learn and perform during my enrolment with you.
2. I will faithfully follow all instructions given me by you and your instructors as to when, where and how to perform and not to perform Yoga exercises, it being understood that any deviation by me from such instructions shall be at my own risk.
3. I will not hold you, your partners, instructors, or employees responsible for any injuries suffered by me caused whole or in part by my failure to faithfully follow the instructions of you or your instructors or by any physical impairment of mine not fully disclosed to you in writing.
4. I understand and acknowledge that I am to receive instruction in Yoga theory and exercises only and I will not hold you, your partners, instructors, or employees to any higher standard of care than that applicable to a school of Yoga theory and exercises.
5. The tuition paid herewith and such registration fees paid hereafter are non-refundable; such refund, if any, as are made will be entirely within the discretion of quickfityoga.

Signed

Date

0411 850 390 PO Box 1757, Buderim, Qld 4556