Registration Form 2011 (Print and mail in)

Name _____________________________________________________

Address _____________________________________________________________________

City __________________ State ____________ Zip __________

Day time  phone (_____)______________   Email address: ___________________________

Cell Phone __________________________  Home Phone _____________________________

Class _______ Day/Time _______  Class _______ Day/Time _______ Class _______ Day/Time _______ 

I hereby agree to the following:  I am participating in the yoga class offered by The Yoga Room during which I will receive information and instruction about yoga and health.  I recognize that yoga requires physical exertion which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.  I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the class.  I knowingly, voluntarily and expressly waive any claim I may have against The Yoga Room, Mike Zolfo and its affiliate teachers for any damages or injury that I may sustain as a result of participating in the class. 
__________________________________ signature                 ______________ date  

(enclose check) total _____________

Make check payable to:  The Yoga Room
Payments are non-refundable and non-transferable to other classes or workshops.

Mail/hand deliver to: The Yoga Room, 418 N. Main Street, Crown Point, IN  46307