 |
| |
 |
| |
 |
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