Bikram's Yoga College of India Hall Street - Registration / Waiver Form

Registration and Liability Waiver
Bikram's Yoga College of India - Hall Street, LLC
3665 SW Hall Blvd. Beaverton, OR 97005

Name: Date: D.O.B.:
Address: City: State Zip:
Home Phone: Work Phone: Email:
(All contact and address information will be kept confidential by Bikramšs Yoga College of India - Hall Street, LLC)
Please check the following:
A) I desire to participate in yoga class(es). I have been examined by a licensed physician within the last six months, found to be in good physical health and able to participate in all yoga exercises for which I am instructed during my enrollment.
B) I will faithfully follow all instructions given to me by the instructor(s), participate with the group to the best of my ability, and rest as needed.
C) I am fully aware of and accept the inherent risks associated with any rigorous exercise program, including Bikram Yoga. I understand that at all times while in yoga class(es) I am responsible for myself, and will respect my body's limitations.
D) I will not hold Bikram's Yoga College of India - Hall Street, LLC, itšs members, partners, affiliates, instructors or employees responsible for any injuries incurred or aggravated by me while in yoga class(es) or on the premises.
E) I have read and understand Bikram's Yoga College of India - Hall Street, LLC's policies, and agree to comply with them.

Please list any physical conditions, impairments, illnesses, or medications:

What physical activities do you participate in?
Running Skiing Hiking Weight Lifting Other(s):
Referred by:
Friend (name):
Internet
Ad/Article
Yellow Pages
Walking/Driving by
Other (how):

DATE: SIGNATURE:

SIGNATURE OF PARENT OR GUARDIAN (if under 18)

Name:		Date:	D.O.B.:
Address:	City:	State	Zip:
Home Phone:	Work Phone:	Email:
(All contact and address information will be kept confidential by Bikramšs Yoga College of India - Hall Street, LLC)
Please check the following: A) I desire to participate in yoga class(es). I have been examined by a licensed physician within the last six months, found to be in good physical health and able to participate in all yoga exercises for which I am instructed during my enrollment. B) I will faithfully follow all instructions given to me by the instructor(s), participate with the group to the best of my ability, and rest as needed. C) I am fully aware of and accept the inherent risks associated with any rigorous exercise program, including Bikram Yoga. I understand that at all times while in yoga class(es) I am responsible for myself, and will respect my body's limitations. D) I will not hold Bikram's Yoga College of India - Hall Street, LLC, itšs members, partners, affiliates, instructors or employees responsible for any injuries incurred or aggravated by me while in yoga class(es) or on the premises. E) I have read and understand Bikram's Yoga College of India - Hall Street, LLC's policies, and agree to comply with them. Please list any physical conditions, impairments, illnesses, or medications: What physical activities do you participate in? Running Skiing Hiking Weight Lifting Other(s): Referred by: Friend (name): Internet Ad/Article Yellow Pages Walking/Driving by Other (how):
DATE:	SIGNATURE: SIGNATURE OF PARENT OR GUARDIAN (if under 18)