Yoga Registration

Full Name*
Phone Number*
    Please indicate your health condition/s if applicable:
    Capal Tunnel Syndrome
    Eye problems
    Knee pain
    Spinal Disorders
    High blood pressure
    Low Blood Pressure
    Any Implants
    Any Surgery in the last five years
    Any other health condition/s that are not listed above. Please explain below
    Emergency Name/Phone Number*

    Agreement of Release and Waiver of Liability Form
    1) That I am participating in the Yoga Class/Workshop, offered by Chinmaya Mission Harleysville during which I will receive information and instruction about yoga and health. I recognize that yoga may require some 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 the Yoga Class or Workshop. I represent and warrant that I am physically fit and I have no medical condition, which would prevent my full participation in the Yoga Class/Workshop.

    3) In consideration of being permitted to participate in the Yoga Class or Workshop, 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 the program.

    4) In further consideration of being permitted to participate in the Yoga Class/Workshop, I knowingly, voluntarily and expressly waive any claim I may have against Chinmaya Mission Harleysville for any injury or damages that I may sustain as a result of participating in the program.

    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.

    Accept Terms*

    I have read and agree to the above Terms and Conditions.

    Signature (Please Print Name)*