EmailMe Form - Spring 2018 Yoga For Osteoporosis: Mat & Standing

Name *
First Last
Home Phone
### - ### - ####
Email *
Mobile Phone
### - ### - ####
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Class fee is $50/10 Weeks. Please indicate below if you are interested in hearing more about available tuition assistance.
How did You first hear about this class? *
Wil-Mar Mailer/Newsletter
Friend/Word of Mouth
Flier
Facebook/Instagram
Google Search
Other
Other:
Comments or Questions?
Informed Consent and Hold Harmless/Release Agreement:
I understand that participation in exercise activities involves a certain degree of risk. I have carefully considered the risk involved and I understand that participation in these activities is entirely voluntary. I understand that class participants will be shown multiple modifications for each exercise and that only I know best which modifications will be the safest for me. I understand this class is not about competition and that all participants should strive to comfortably self-challenge while exercising at the level appropriate to each individual's skill set and health. By printing my name below, I release the Wil-‐Mar Neighborhood Center and Ellen Barnard from any and all claims of liability arising out of my participation in this class. Photos may be taken during a session and I allow these to be used for educational and marketing purposes. *
I have read and agree to the above statement.