Date of Birth (IF YOU ARE UNDER THE AGE OF 18, THIS AGREEMENT MUST BE COMPLETED BY YOUR PARENT OR LEGAL GUARDIAN. PLEASE CONTACT marcie@nourishingbreathyoga.com FOR THE APPROPRIATE FORM). *
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Phone number: *
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Person to contact in case of Emergency: *
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Which class/series are you registering for? *
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Check any area where you have pain, problems, or limitations:
Please list all other physical conditions, limitations, concerns, or injuries
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Are you physically pregnant, or have you had a child within the past three months?
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How did you learn about this class?
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