Brooklyn Yoga Intake Form & Waiver

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Please take the time to fill this form out thoughtfully as it will help me to support your journey!

Yours,

Kate

Email *

What inspired you to sign up for this yoga class? What benefits are you looking for? *

What’s your biggest issue that you need help with? What do you wish could be different?

I will always respect your privacy. Please let me know about any relevant medical conditions as well as physical, emotional or mental challenges you are currently experiencing.

Waiver:

I, the undersigned client, understand that the activities involved in yoga and meditation may involve physical, emotional, and psychological activity. In these cases there’s always some risk involved.

I understand that I am responsible for assessing the risk that any activity poses to me, and then making safe and empowered choices for myself.

I agree to assume the risk and responsibility for any injuries or damages arising out of my participation in this retreat with Kate Lynch.

I agree to immediately communicate any concerns which arise to Kate (or the appropriate retreat center staff member).

Yes

Required

I, the undersigned client, have read and understand the statements above. Please sign your full name here: *

Date: *

YYYY

Do you have a yoga mat? *

Yes

Other:

Thank you. I look forward to supporting your journey.

Please write me with any questions at Kate@healthyhappyyoga.com

Send me a copy of my responses.

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