New Client Health Declaration | Kate Tittley Yoga

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Kate Tittley Teacher of Rocket, Mandala, Barre, Yin, & Prana Yoga

WHAT I OFFER
E.Z.E MEMBERSHIP
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- TESTIMONIALS
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First Name

Last Name

Email

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

No

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

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