REGISTRATION AND DISCLAIMER FORM
YOGA CONNECTION
REGISTRATION, MEMBERSHIP AND DISCLAIMER AGREEMENT

Membership No: ________

CHECK ONE: Class Package: 10 _____ 15_____ 30_____ 45 _____75_____ Kid's Package ______

                  Unlimited Monthly____ Unlimited Yearly_____ Unlimited Mo. Contract____ Six Mo. Contract _____

NAME: ______________________________________________________________________________

ADDITIONAL FAMILY MEMBERS: ___________________________________________________________

ADDRESS: ___________________________________________________________________________

HOME PHONE: _________________ BUS. PHONE: _____________________ CELL:_________________

E-MAIL ADDRESS:___________________________ REFERRED BY: _____________________________ 

In consideration of and as inducement to participating in classes, private lessons, group lessons, trainings and workshops at Yoga Connection or at another facility if instructed by Yoga Connection staff, I represent and expressly agree that:
1. I am in good health, have been examined by a licensed physician within the past six months and have been found by my physician to be in good physical health and fully able to perform all yoga and pilates postures and exercises, in all styles of yoga and pilates.
2. I am to receive instruction in yoga and pilates practice, in both theory and exercise. I will not hold Yoga Connection, it’s partners, instructors or employees to any higher standard of care than that applicable to a school of yoga and pilates practice.
3. I hereby assume full responsibility for my education and practice of yoga and pilates; and I further assume any and all risk of bodily injury, death or property damage I may sustain, whether due to negligence or otherwise. In addition, if I elect to use or rent mats, blocks, straps, balls or any props or equipment from Yoga Connection, I understand that such equipment has been used and shared by other students, and I further and fully assume all risk and responsibility for infection, disease, bodily injury, death or damage I may sustain, whether due to negligence or otherwise. I hereby release, waive, discharge, covenant and agree not to sue, and to defend and hold harmless W.J.S.J., Inc d/b/a Yoga Connection, it’s owners, instructors, agents and employees (all hereinafter collectively called “Releasees”) for, from and against any and all liability, loss, cost or damage, and any claim or demands therefore, including attorney’s fees, court costs (not limited to taxable) and any other expense that may be incurred by Releasees, on account of injury to person or property, or resulting in injury or death, whether caused by or due to the negligence of the Releasees or any one of them, or otherwise while I am in or upon the premises operated by the Releasees or any one of them, or while I am at another facility instructed by representative(s) of Releasees. This provision shall also bind my personal representatives, assigns, heirs and next of kin.
4. This release, waiver, indemnity and hold harmless Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida, and that if any portion of this Agreement is held invalid or unenforceable, the balance shall, notwithstanding, continue in full force and effect.
5. The terms of this Agreement are contractual and not a mere recital.
6. The terms of this Agreement are applicable to me whether I am a single class student or a member student of Yoga Connection or a student at a facility outside of the premises of Yoga Connection being instructed by Yoga Connection staff. I agree further that I will abide by all rules and regulations as established at Yoga Connection for the students and members thereof.
7. I understand that any and all tuition, registration, class and membership fees are non-refundable and non-transferable.
8. If I am a member student of Yoga Connection, I will abide by all terms, deadlines and other restrictions or requirements that accompany my particular type of membership.
9. I have read, understand and voluntarily signed this Agreement. I further agree that no other oral or written representations, statements or inducements have been made. I sign this Agreement as my own free act.

Date: ___________________ Printed Name:__________________________ Signature:____________________

PARENT FOR MINOR CHILD:
PRINT NAME: ____________________________ SIGNATURE: ______________________________
CHILD’S NAME: _____________________________________



Payment:    Check_______    Check Number: _________   Check Amount:_____________________________

                

Credit Card Number:______________________________________________________________
                  Visa___________  Mastercard_____________  American Express__________

                  Expiration Date:_________________________

                  Name on Card:___________________________________________________________________

                 

                  Signature:_______________________________________________________________________