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Rivertide Intake Package: General
Intake and release form for joining aikido, yoga, or other practice at Rivertide Center.
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* Indicates required question
Email
*
Your email
Student's Name:
*
Your answer
Pronoun
*
They / them
She / her
He / him
Other:
Required
Student Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian Name(s) if under 18
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Have you ever practiced Aikido, Yoga or Iaido before? What kind and for how long?
*
Your answer
What are your goals in joining this class/program? (Check any that apply.)
*
Fitness
Mind-body connection
Self-defense
Other:
Required
Please list any injuries, medical issues, and/or physical limitations:
*
Your answer
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