Teacher Training - Registration Form Short - Taylore Carre's Divine Balance

Section A: General Information
Today's Date
DD slash MM slash YYYY
Name
Your Date of Birth
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Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Occupation
Section B: Training you are registering for
Course Title
Fill in with the course you are joining for with the price
Location
Section C: Short Health Questionnaire
Health History: please let us know about any injuries you might have. Are you pregnant? Do you have any medical / health conditions which will prevent your full participation in the class?
Section D: Method of Payment
Please let us know how you will be paying the tuition fee
Agreement of Release and Waiver of Liability
Please read and sign this waiver. Electronic and typed signatures have the same force and effect as manual signatures.
By signing and submitting this waiver, you hereby agree to the following:

1) That I am participating in a YBR® training class or YBR® Workshops offered by Yamuna Studio, Inc. during which I will receive information and instruction about YBR®. I recognize that this fitness program involves physical contact and requires physical exertion which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
2) I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the YBR® training classes or workshops. I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation.
3) In consideration for being permitted to participate in YBR® training classes or workshops, 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 program.
4) I understand that I have the right and duty to inspect the mats, facilities and equipment to be used and if I believe that anything is unsafe or beyond my capability I will immediately advise the instructor or supervisor of such condition(s) and refuse to participate.
5) In further consideration of being permitted to participate in the YBR® training classes, programs or workshops, I knowingly, voluntarily and expressly waive any claim I may have against Yamuna Studio, Inc., its officers, instructors or employees for injury or damages that I may sustain as a result of participating in the program.
6) I, my heirs or legal representatives foreseer release, waive, discharge, and covenant not to sue Yamuna Studio, Inc. its officers, instructors or employees for any injury or death caused by their negligence or other acts.
7) I understand that until I complete all of the YBR® requirements I am not a certified practitioner and will not teach or use the work with my clients.
I have read the above release and waiver of liability and fully understand its contents as well as the Refund/Cancellation Policies. I voluntarily agree to the terms and conditions stated above.
Signature
Date
DD slash MM slash YYYY
Printed name
Name
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Section A: General Information

Section B: Training you are registering for

Section C: Short Health Questionnaire

Section D: Method of Payment

Agreement of Release and Waiver of Liability