top of page

New Student Form

Please take a moment to completely fill out this form before you attend class - THANK YOU !

Legal Name & Address

Contact Information

Other Info

How did you find out about us (check all that apply)?

Emergency Contact

Release of Liability

I authorize the collection and use of the above personal information as is required for legal, safety, and administrative purpose. I understand that all my personal information is confidential and will not be released without my signed consent. I understand that classes at CITYOGA may be physically strenuous and I voluntarily participate in them with full knowledge that there is a risk of personal injury, property loss, or death. I agree to be gentle with myself and I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against CITYOGA or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.

Thanks for submitting!

bottom of page