Registration and Disclaimer Form

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If you have any injuries or health concerns, please ask for your doctor before registering for classes.

Email *

Name *

Date of Birth *

YYYY

Address *

Phone *

Emergency Contact *

Do you have any existing or past injury *

Yes

If you have any existing injury, tell us more about it *

Disclaimer: I acknowledge that it is my duty to exercise ordinary care for the protection of others and myself while attending a yoga class or other classes provided by The Zen Cove Studio. I assume the risk of physical activity with my own physical condition. I have received advice from my doctor that I am capable of physical exercise such as provided by The Zen Cove Studio, or I will seek such advice, or I will assume the risk of exercising without a doctor’s examination. This form continues to be effective as long as I am taking classes provided by The Zen Cove Studio or from its instructors in The Zen Cove Studio or other locations. I take complete responsibility for my presence at The Zen Cove Studio and I will not hold Dini Maharani Suskandi or any other instructors or The Zen Cove Studio responsible for any injuries or loss I may incur as a result of my participation in any yoga classes or other classes and for any time I am taking classes. I hereby confirm that I have read and fully understand this release of liability and assumption of risk agreement, fully understand its terms, and sign it freely and voluntarily without inducement. *

Agree

By typing your full name below, you are agreeing to our terms and conditions of our disclaimer above. *

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