Welcome New Students!Please fill out this form before your first class. Name * First Name Last Name Email * Check the box below to get updates and special offers. If unchecked, you will not receive newsletters and special offers. Subject Please tell me which class you would like to attend. How did you hear about yoga with Jennifer Davis? Survey Do you want to build strength? Strongly Disagree Disagree Neutral Agree Strongly Agree Would you like to improve your balance? Strongly Disagree Disagree Neutral Agree Strongly Agree Do you want to enhance your mobility/flexibility? Strongly Disagree Disagree Neutral Agree Strongly Agree Would you like to reduce low back pain? Strongly Disagree Disagree Neutral Agree Strongly Agree Additional goals. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of birth * MM DD YYYY Phone Please add your phone # if you would like me to text you links to classes. (###) ### #### Medical Conditions Please list any relative medical or physical conditions including past or present injuries, surgeries, illnesses, pregnancy or other conditions our instructors should be aware of: Emergency Contact First Name Last Name Emergency Phone (###) ### #### Release * I release Jennifer Davis and her employees, investors, agents, successors and assigns and will hold them harmless from any and all liability arising out of any personal injuries or damages, foreseeable or unforesee- able, which may occur as a result of my participation in any class or program or activity led or sponsored by Jennifer Davis. I hereby declare myself physically and mentally sound and capable of participation in those activities, programs and classes. Yes Thank you, your new student form has been submitted. I look forward to having you in class!
