Rubber Soul Yoga Revolution AcroYoga Application Form

Name: ____________________________________

Email: _________________________________

Phone: _____-________________________

How did you learn about this class?

Do you have any knowledge or experience with AcroYoga? If so, what is your knowledge base/experience?

What exactly is it that interest you about AcroYoga and this class?

If given a spot in this class would you be able to commit for the entire series and attend all classes?

Please discuss any prior injuries, weaknesses, or health concerns that could potentially affect your participation in this class.

Agreement of release and waiver of liability:
Please read and sign:
I hereby agree to the following:  1.  That I am participating in yoga classes during which I will receive information and instruction about yoga and health.  I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.  2.  I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga classes.  I represent and warrant that I am physically fit and have no medical condition that would prevent my participation in yoga classes.  3.  In consideration of being permitted to participate in the yoga classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I might incur as a result of participating in the program.  4.  In further consideration of being permitted to participate in the yoga classes, I knowingly, voluntarily, and expressly waive any claim I may have against the instructor, the owner, or the leaseholder of the building for injuries or damages that I may sustain as a result of participating in classes or workshops held by Rubber Soul Yoga Revolution. 5. That if I participate in other classes or events at Rubber Soul (such as dance, pilates, trapeze arts, circus arts, theater, martial arts) that I will also assume full responsibility for any injuries that may result from my participation, with the same considerations that this waiver stipulates for yoga (items 1-4 above).
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.
Date: _______________
Signature of participant: _________________________________
If participant is under 18:  As legal guardian of _________________________, I consent to the above terms and conditions.
Signature of parent/guardian: ________________________

Please attach the class tuition and place in the donation box at Rubber Soul.