Membership Purchase Form - One time

Membership Type *

First Name *

Last Name *

Date of Birth

Gender *

Email *

Phone *

Street Address *

City *

State *

Country *

Postal Code *

Emergency Contact Name *

Emergency Contact Number *

Did you have Neck/Back/Spine injury:

Did you have Joint injury (ankle, knee, hip, elbow shoulder)? *

Did you have muscular injury? *

Other medical condition, injury, or disability

Any recent surgery?

Do you feel stressed/anxious? Rank 1–10

Yoga Level *

Preferred Days for Classes *

Note: • All sales are non-refundable and non-transferable. • Classes must be canceled at least 2 hours before the start time to avoid charges. Late cancellations and no-shows will be considered attended and charged accordingly.

Waiver and Release: By signing this form, I acknowledge that I am voluntarily participating in yoga classes and understand the associated risks. I kindly release the instructor and the organization from any responsibility or liability for any injury or harm that may arise during my participation.

I consent to receive SMS alerts & marketing communication.

Membership Purchase Form – One time