2024 Yoga by Bethanie Participation Form

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This is your Waiver & Data Collection Form to participate in any/all group activities hosted by "Yoga by Bethanie, LLC." during 2024 - This form must be completed entirely online before the start of any in person or online Event or yoga session, public or private.

Be assured, your private information remains private with me. I promise not to sell this info to anyone

Email *

I would like to receive your monthly newsletter via email. *

Yes. I'm already getting it (:

Yes, Ill add myself: https://yogabybethanie.us17.list-manage.com/subscribe?u=8bc6500fdc5b0ddcf9ef13a7d&id=ab2e62ace3

Legal First Name *

Legal Last Name *

Gender *

Female

Male

Date of Birth *

Full Mailing Address *

Mailing Address Zip Code *

Primary Contact Phone # *

Have you ever practiced yoga before? *

Yes - Traditional yoga practice

Yes - A Christ-Centered yoga practice

Never practiced yoga before

Required

Waiver: ---> I hereby consent as a participant in Yoga by Bethanie, LLC activities (classes, retreat, workshop, online discussion) and agree to assume all of the risks involved. I understand that Yoga by Bethanie, LLC does not provide medical insurance relative to accidents, injuries, and/or death as a result of program related activities; and that I cannot hold Yoga by Bethanie, LLC or appointed or affiliated Yoga by Bethanie, LLC teachers or host sites 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, ailment, impairment, disease, or other illness that would prevent my participation in Yoga by Bethanie, LLC activities (live online, online, pre-recorded, or in-person). ---I agree that Yoga by Bethanie, LLC and Bethanie Meredith may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *

Agree

Required

I agree that Yoga by Bethanie, LLC and Bethanie Meredith may use touch therapy and/or hands on adjustments as needed for proper alignment and/or additional stretch. *

Yes

Emergency Contact (Name & Relationship) *

Emergency Contact Phone Number *

My Full Name - Once Again *

A copy of your responses will be emailed to the address you provided.

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