Orenda Yoga and Healing Arts Registration Form
       
       
               
       
                                                           

Name_____________________________________________________________

Mailing Address_____________________________________________________

City_________________________  State________  Zip_____________________

Phone____________________________________________________________

E-mail____________________________________________________________

Class /
Workshop_______________________________________________________

Deposit, Date___________   Balance Due________________________________

Balance Paid, Date________________  coupon/code_______________________

Please indicate physical limitations or conditions ( if any )  you feel may be important
for Orenda staff to be aware of concerning your participating in classes.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

PLEASE READ AND SIGN

I am responsible for my own health and actions. I have consulted with a physician, if
necessary,  in regards to my participating in activities and programs offered herein. I
shall undertake these classes at my sole risk. Orenda Yoga and healing arts and its
sub-contractors shall not be liable for injuries ,or damages to my person or property
arising out of , or in connection with the use of the services and facilities of the
premises. I release Orenda Yoga and its Instructors from all cause of action.


Signature _____________________________________________DATE________  
                             ( parent or guardian for minor under 18  )


Please make checks payable & mail to :
ORENDA YOGA  
PO Box 104 , Guilderland Center, NY 12085