wild woman | yoga | health waiver

To register for our yoga class, please fill out the following medical waiver.

First Name

Email Address

Last Name

Date of Birth

Do you have any health conditions that would restrict your physical activity?

No

Yes

Do you have the consent of your family physician to practice yoga?

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete.

Thanks for submitting!