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PLEASE FILL ALL FIELDS.

Help us go green-er!

Read carefully before signing

The undersigned assumes all responsibility for all risk of damage or injury that may occur to the undersigned as a student of the Devanand Yoga Center, Inc. Course of Instruction (referred to in this assumption of risk agreement and release as yoga course), while attending classes, participating in exercises, using yoga course equipment or facilities, or following yoga course instructions in or out of a yoga course studio or location. In consideration of being accepted as a student in the yoga course, the undersigned releases and discharges course and all associated studios, its and their owners, employees and agents from all claims, demands, rights of causes of action, present or future, whether known, anticipated or unanticipated, resulting from or arising out of, or incident to, the undersigneds use (or intended use) of a yoga course studio location, or facilities and equipment in such place or as a result of, incident to, engaging in yoga course exercises or otherwise following yoga course instructions anywhere.

I have read and understand and sign the foregoing assumption of risk agreement and release.

I Agree

October 16, 2021

First yoga student's Name

First Name*

Last Name*

Phone*
First yoga student's Date of Birth*
I certify that I am 18 years of age or older
First yoga student's Signature*
Second yoga student's Name

First Name*

Last Name*
Second yoga student's Date of Birth*
Third yoga student's Name

First Name*

Last Name*
Third yoga student's Date of Birth*
Fourth yoga student's Name

First Name*

Last Name*
Fourth yoga student's Date of Birth*
Fifth yoga student's Name

First Name*

Last Name*
Fifth yoga student's Date of Birth*
Sixth yoga student's Name

First Name*

Last Name*
Sixth yoga student's Date of Birth*
Seventh yoga student's Name

First Name*

Last Name*
Seventh yoga student's Date of Birth*
Eighth yoga student's Name

First Name*

Last Name*
Eighth yoga student's Date of Birth*
Ninth yoga student's Name

First Name*

Last Name*
Ninth yoga student's Date of Birth*
Tenth yoga student's Name

First Name*

Last Name*
Tenth yoga student's Date of Birth*
yoga student's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information and DYC news by e-mail (we rarely do this)...
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Anything your instructor needs to know?

Any medical conditions the yoga instructor needs to know? *
How did you hear about us?
Internet
Word of mouth
Drive by
Other
Coupon (e.g., Groupon, etc)

If coupon (eg., Groupon), please enter the number.
Our Prices

Pay cash/check at the center or via (Paypal) on our website.

  • $15/class, or 
  • $89/month - unlimited
Money should not be an impediment to practice.
Ask about our reduced rates or yoga for seva (volunteer) options!

$89/month, unlimited attendance
$15/class
Coupon/Other (e.g., Groupon)
Undecided
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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