Selah Yoga with Mia Private Intake Form
I'm so excited that you've decided to put You first and take some time for self-care! Selah Yoga with Mia is one of the wellness offerings of Beyond the Busyness, LLC. It is my honor to guide you through this healing practice.

Submit this form to reserve your class and send your payment via CashApp:$miabradfo or Venmo:@Mia-Bradford. If you would prefer an invoice, you can indicate this below. Each person participating needs to register by completing this form for safety purposes.

For your practice, please have pillows, blocks (books are good substitutes), water, and a small towel near by. You can practice on the floor, a towel, a blanket, or a yoga mat.

If you are practicing in person, you will receive an email to confirm the date and another with the location 24 hours before your class starts.

If you are practicing virtually, find a room in your home with good lighting that allows me to see you and place your device around 3 feet in front of your mat. Here's a tip, find a window and place your mat in front of it. If the window is behind you, I will not be able to see you.

You will receive a zoom link and class reminder 30 minutes before the start of class.

As always, reach out if you have any questions. I am excited to practice with you!

Wishing you many more hours of self-care,
Mia
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Email *
I would like to receive an invoice for payment *
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Name *
Email Address *
Phone Number
Text Message Class Reminders *
Emergency Contact (Name and Phone Number) *
Any injuries that may impact your practice? *
(For in-person classes) Do you mind if I use essential oils in our practice?
By my clicking I agree below, I certify that I am physically able to practice yoga and do hereby agree that Beyond the Busyness, LLC and Mia Bradford are not responsible or liable to me for any injury, accident or loss of personal property. I do hereby release Beyond the Busyness, LLC and Mia Bradford from any claim or cause of action which may have occurred as a result of any medical problem known or unknown which I have knowledge presently or in the future. I agree to follow the instructional guidelines presented by Beyond the Busyness, LLC and Mia Bradford. I certify that I have read this agreement and agree to the terms herein. * *
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By clicking I agree below, I acknowledge that I know I will be recorded on Zoom. If I do not want to be recorded, I will turn off my camera. I understand recordings will only be accessed by members of the workshop/class. *
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Please share what you would like to get out of this experience.
Do you have any concerns about practicing yoga?
Do you have a preference for style of yoga? If so, please share.
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