Yoga Participation Form

All prospective yoga students are asked to please complete the form below. If you would rather print the form and bring it with you to your first class, you may click here to download the PDF form.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Emergency Contact*
First Last
Emergency Phone*
Experience and Expectations
It is important for your yoga practice to fit your needs. Please let me know of anything that may influence your practice. Thank you!
Describe your experience with yoga, meditation, or other stress management techniques:
Please describe your history of injuries, accidents, surgeries, major illnesses, chronic conditions, emotional health:
List any Prescription/Non-prescription drugs taken on a regular basis:
What do you hope to gain from these sessions?
Disclaimer and Participation Agreement
The practice of yoga/yoga nidra may include physical movements, positioning, and breathing practices. As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. Please inform me about any health conditions, or changes in your health that could be affected by your practice of yoga. If you are unsure about your condition, please consult with your physician. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Please follow my guidance, listen to your body, and report any discomfort to avoid injuries.
I have read, understand, and agree to the above statement. I hereby agree to irrevocably release and waive any claims against Corinne Peterson, now and in the future.*
- I understand and agree.
Please enter the characters you see below.

Yoga Participation Form

Yoga Participation Form

Experience and Expectations

Disclaimer and Participation Agreement