Under 16 – Guardian Consent

Yoga is for everybody. Yoga is for every body.

Teen Yoga Registration Form

What Class do you wish to Enrol For: ___________________________________________

**Please note, all of the information on this form is kept strictly confidential.

Name: ___________________________________________

Parent’s Name:_____________________________

Address: ___________________________________________

Parents Phone: ________________________________Age:____


2nd Guardians Name & Address: _______________________________________________________________________

Contact Mobile Phone: ____________________________________________

Have you practiced yoga before? YES/NO (Please circle).

Please list any Medical Issues or Injuries? _______________________________________________________________________

Known Allergies: _______________________________________________________________________

Do you have any numbness or pain in (circle all that apply): neck, shoulders, elbows, hands, wrists, hips, lower back,upper back, knees, feet, other (please note below): __________________________________________________________________________

LIABILITY DISCLAIMER & NOTICE I individually and as parent and or/guardian of the child identified above hereby acknowledge that I have voluntarily chosen and request my child to participate in yoga class and grant that: FOURTH WAVE YOGA takes all reasonable care in ensuring that its programmes are safe. However, I agree that my teenager will be engaging in physical activities that may involve some risk of injury. I acknowledge I have received advice from my teenager’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my teenager’s participation in yoga. I assume the above risks and accept responsibility for any injury sustained by my teenager and discharge and hold harmless FOURTH WAVE YOGA, its owners and personnel including its teachers and from any liability arising from any injury to my child or other persons or property caused by child attending this Yoga Class.

_________________________________ Parent/Guardian Signature