BALANCE Yoga and Fitness Studio: Health Waiver and Intake Form-BALANCE Studio

BALANCE Yoga and Fitness Studio: Health Waiver and Intake Form

Please take a minute to fill in the following information. Thank you!

First Name

Last Name

Phone Number

Date of Birth

Address

Do you have a doctor’s permission to participate in physical activities?

Yes

Do you have any joint replacements, injuries or limitations to physical movement or activity? If yes, please describe in detail below.

Emergency Contact Name

Emergency Contact Phone Number

I have read, agree, understand and all my questions answered in regards to the content listed in POLICIES AND WAIVERS on the BALANCE website www.BALANCEyafs.info

Your Signature

Health Waiver and Intake form - Date signed

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