New Creation Yoga Registration

I hereby consent as a participant in New Creation Yoga/ Holy Yoga classes and agree to assume all of the risks involved. I understand that New Creation Yoga/ Holy Yoga/ Hickory Grove Baptist Church does not provide medical insurance relative to accidents, injuries, and/or death as a result of program related activities; and that I can not hold New Creation Yoga/ Holy Yoga/ Hickory Grove Baptist Church or affiliated Holy Yoga teachers personally responsible for any liability.

I recognize that any form of physical activity is a potentially hazardous one, and that they involve a risk of possible injury or even death.  I hereby affirm that I am voluntarily participating in these activities with the knowledge of the risk involved.  I agree to expressly assume and accept any and all risks of injury and/or death. 

I hereby affirm myself to be physically sound and suffering from no condition, aliment, impairment, disease, or other illness that would prevent my participation in New Creation Yoga/ Holy Yoga activities,  I declare that I have disclosed any and all medical history to New Creation Yoga/ Holy Yoga and/or their affiliates relevant to participation.

In consideration of my participation in New Creation Yoga/ Holy Yoga, I release Jennifer Reavis and Hickory Grove Baptist Church from any claims, demands, and causes of action as a result of my voluntary participation and enrollment.

 
* I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS      
* Name
       
Address
     
Phone Number
ex. (xxx-xxx-xxxx)
     
Email Address
     
Date of Birth      
* Have you ever participated in yoga? YES NO      
If Yes, when and how often?
     
* Do you have any medical restrictions or conditions? YES NO      
If YES, please explain.