NEW CLIENT FORM

Name *
Name
Telephone *
Telephone
D.O.B *
D.O.B
Anything that has affected you in your day to day life in the past year. eg) sprained ankle; broken bone; depression; etc.
Do you have any of the following?
I understand that A Health House and its partners will provide yoga instruction and teaching. I understand the instructions are intended as guidance only. I take full responsibility to adjust my own practice to ensure no personal injury occurs. Accordingly, I hereby take the full risk for any injury or loss I may suffer whilst practicing yoga and I waive any claim that I might have at any time for any injury or loss of any sort against A Health House and it's partners. I have carefully read this release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions above.

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