EMPOWERED YOGA NEW STUDENT FORM (ONLINE)

PLEASE TAKE A MOMENT TO COMPLETELY FILL OUT THIS FORM – THANK YOU!

(Please Read!) Agreement of Release and Waiver of Liability: In signing below I agree to the following: I am participating in a yoga class offered by Johnny Fitness, LLC. I recognize that any class offered involves physical stress and may be strenuous. I acknowledge that I have had an opportunity to speak to the instructor of the class prior to the class to discuss any questions I have about the nature of the class and the level of physical activity involved. I am fully aware of the potential risks that are involved with taking this class. I assume full responsibility of any risks, injuries, damages, known or unknown, which I might incur as a result of participating in this class. I understand that it is my responsibility to consult a physician prior to and regarding my participation in this yoga class. I represent and warrant that I am physically fit and have no medical conditions that prevent my participation in this yoga class.

I hereby voluntarily waive any claim I have against Johnny Fitness, LLC and their agents, employees, principals, officers, and members for any injuries that I may sustain as a result of participating in the yoga program.

*Release of Liability - SIGNATURE (Please type in your full name as your signature)

COURSE INFORMATION

*LOCATION: Wilmington Newark
*COURSE: Morning BNB Evening BNB

*What month are you signing up for?

*PAYMENT TYPE: Cash Check Credit Card Gift Certificate
(Be advised that we're not able to complete registration without a payment. Please make payments as soon as you send this form and feel free to call us if you have any questions. Gift certificates have to be redeemed in person or over the phone.)

CONTACT INFORMATION :

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(We respect your privacy. We will never share your information to anyone or to any organization).

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*HOW DID YOU HEAR ABOUT US?

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