Nature Space Yoga: 2020 Registration

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Emergency Contact Name *

First Name Last Name

Emergency Contact Phone Number *

Area Code Phone Number

Have you ever done yoga or meditation before? *

Yes, Yoga Yes, Meditation Yes, Both yoga and meditation No, Neither yoga or meditation

Have you taken a Nature Space Yoga Class before? *

Yes (If yes,you can skip the remaining questions) No

Tell me a little about your yoga and/or meditation experience (if applicable) *

Do you have any physical conditions that I should be aware of to ensure you have a safe and effective yoga practice? If yes, please describe:

Please select your registration options: *

Fall Yoga at the Church (6 week session starting Tues, November 10th)= $50 Yoga : Single Class Drop-in= $13 Yoga participant with a pre-existing 2020 class pass= $0

Periodically, photos will be taken to be used for our website or other promotional materials. As a small business, these kinds of photos are helpful to grow and support our business. Do you consent to your photo being taken and used in this manner? *

Yes No

Covid-19: Disclosure. Please tick ALL boxes to indicate understanding. I understand that I cannot participate in Beach Yoga if I: *

Have any symptoms of Covid-19 including cough, fever/feverish, difficulty breathing, fatigue, sore throat/runny nose Have been in contact with someone with symptoms of Covid-19 or an active Covid-19 infection Am self-isolating or in contact with someone who is self-isolating Have traveled off-island in the past 14 days or have had close contact with someone who has traveled

Should I become infected with Covid-19, I will inform Nature Space Yoga by emailing Heather Gunn McQuillan at naturespaceyoga@gmail.com, so that contact tracing can be performed to protect all participants. *

I Agree

Please print your name to acknowledge you understand this requirement. *

Upon submitting this form, you will be contacted by Nature Space Yoga to arrange payment through e-transfer or credit card. E-transfers can be made to naturespaceyoga@gmail.com with the security answer naturespace (all one word).

Waiver: By clicking submit, the participant agrees that while participating in Nature Space Yoga classes or workshops, they acknowledge that they assume all risks associated with participating in a yoga or meditation class, and release and hold harmless Nature Space Yoga and its instructors from any legal or equitable claims, demands, debts, law suits, or causes of action in the past, present, or future for any or all injury, disability, death, and loss or damage to person or property. Participants also waive any right to pursue legal action related to partipating in a Nature Space Yoga class and contact or infection with Covid-19.