Zoom Yoga Intake

Completing this form will help me understand how to facilitate your participation in online yoga classes. All fields other than contact information are optional and your information is kept strictly confidential.

    Your Full Name (required)

    Your Email (required)

    Optional Emergency Contact

    Emergency Contact Name

    Emergency Telephone

    Relation (mother, brother, friend, etc.)

    Survey

    What are your current reasons for practicing Yoga online? Do you have a goal for our time together?

    Do you have any current or previous health conditions? Please include any relevant medical diagnoses, surgeries, accidents, injuries, etc.

    What are your favorite physical movements? Least favorite? Do you have a regular
    exercise program? If so, please describe:

    Release of Liability

    I understand that yoga includes physical movement, breath-work, meditation, and stretching techniques. As is the case with all physical activity, I understand that the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort I will listen to my body, adjust or change the posture, and inform and seek assistance from my teacher.

    I know that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I also know that all suggestions made by the Yoga Instructor are just suggestions and I am responsible for doing my own research and consulting a doctor before starting any new regimens, including yoga and strength routines. I understand that yoga is not safe under certain medical conditions and take full responsibility for making the informed decision to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Justin Morrison.

    By checking this box assert I have read and agree to the above terms:

    Privacy

    All communications including the above information, email, phone calls and texts, are strictly confidential and will not be shared with any party, under any circumstance, for any reason.

    Do you have additional comments for Justin?