Emergency Contact Form

WHO DO WE CONTACT IN AN EMERGENCY
PLEASE FILL IN CONTACT DETAILS:

Contact First Name

Contact Last Name

This contact is my

Contact Phone Number

Contact Email

Thanks for submitting!
We’ll contact this person only in case of emergency.

Yoga Online

Health Liability Waiver

First Name

Last Name

Email

Phone

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

No

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Join Monthly News

Thanks for submitting!

Up

Privacy Policy | Code Of Conduct

HEALTH WAIVER

Emergency Contact Form

WHO DO WE CONTACT IN AN EMERGENCY PLEASE FILL IN CONTACT DETAILS:

Health Liability Waiver

Join Monthly News

WHO DO WE CONTACT IN AN EMERGENCY
PLEASE FILL IN CONTACT DETAILS: