Registration Inverness Yoga and Wellness, New Student Form Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Date of Birth* MM DD YYYY Please list any current or chronic medical conditions and/or medications (pregnancy, illness, pain, injury, etc.)*For marketing purposes: How did you hear about Inverness Yoga and Wellness Center?*1. That I am participating in yoga classes, special interest classes or workshops offered by Inverness Yoga and Wellness Center during which I will receive information and instruction about yoga and health. 2. My signature verifies that I am physically fit to participate in the classes offered and if under any medical care have consulted with a licensed medical doctor to verify that I am able to participate in any of the classes, special interest classes, or workshops offered by the studio. 3. If I am pregnant, or become pregnant, or am post-natal, my signature verifies that I am participating in Yoga, or any other exercise classes, with my doctor's full approval. 4. Yoga and any physical exercise is an individual experience. I understand that in Yoga, and in any other class offered, I will progress at my own pace and that at any point I feel overexertion or fatigue, I will respect my own body's limitations and I will rest before continuing with the class. 5. I assume responsibility to update Inverness Yoga & Wellness Center of any changes in my medical condition that might affect my safety or participation in any classes at Inverness Yoga & Wellness Center. 6. I have read the above release and waiver of liability and fully understand its contents and voluntarily agree to the terms and conditions stated above. I assume all responsibility for, and all risks of damage or injury that may occur to me as a student in Inverness Yoga and Wellness Center courses and instruction, while attending and participating in any classes, using Inverness Yoga and Wellness Center facilities or following Inverness Yoga and Wellness Center instructions in or out of Inverness Yoga and Wellness Center studio. My signature is binding to this liability waiver from this day forth.* First Last Today's Date* MM DD YYYY IF UNDER 18 YEARS OF AGEAs legal guardian of the above, we consent to the above conditions. First Last Today's Date MM DD YYYY
