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TODAY'S DATE: May 25, 2018

New Student Information Sheet and Release of Liability Waiver

 Sumits Yoga Colleyville New Student Registration

In consideration of and as an inducement to enrolling me as a member of SUMITS YOGA COLLEYVILLE, I represent and agree as follows:

  1. I have been examined by a licensed physician within the past 6 months and have been found by such to be in good health and fully able to perform all Yoga exercises which I am to learn and perform during my membership with SUMITS YOGA COLLEYVILLE.
     
  2. I will faithfully follow all instructions given to me by SUMITS YOGA COLLEYVILLE instructors as to when, where, and how to perform and not perform Yoga exercises, if being understood that any deviation by me from such instructors shall be at my own risk. 
     
  3. I will not hold SUMITS YOGA COLLEYVILLE, partners, instructors, or employees responsible for any injuries suffered by me caused in whole or part by my failure to faithfully follow the instructions of said or by any physical impairment of mine not fully disclosed to you in writing. 
     
  4. I understand and acknowledge that I am to receive instruction in Yoga theory and exercise only, and I will not hold SUMITS YOGA COLLEYVILLE, partners, instructors, or employees to any higher standard of care than that applicable to school of Yoga theory and exercises. 
     
  5. The tuition paid herewith and such registration fees paid hereafter are non-refundable, such refunds if any, as are made shall be entirely within the discretion of SUMITS YOGA COLLEYVILLE. 
     
  6. I understand that SUMITS YOGA COLLEYVILLE will provide an area for personal belongings to be held during class, however, I agree that SUMITS YOGA COLLEYVILLE is in no way responsible for the loss or damage of my belongings while I attend class or at the facility. 
First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
11 Student's Name

First Name*

Last Name*
11 Student's Date of Birth*
Student's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Referred By: (please check one)
Referral Type

If Another Client, please list name:

If Other, please list:
Emergency Contact Information

Name*

Relationship*

Phone*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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