Mindful Yoga Registration

Mindful Yoga Registration Form

Pre-Holiday 4-Class Session 2019

4 Tuesdays, 5:30-6:30 p.m.
11/19, 11/26, 12/10 and 12/17 (No class on 12/3)
Thiensville Health Alliance, 136 N. Main St., 3rd Floor (Indaba Room), Thiensville
Fee: $48.00
Instructor: Todd Dybul (Min-9 | Max-15 participants)

Questions? Please contact todd.dybul@gmail.com or 262-613-2385...Thank you and we'll see you at our first class! Todd

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Name *

First

Last

Email *

Phone *

Address *

Line 1

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City

State

Zip Code

Country

Have you practiced yoga? No/Yes (Style) *

Emergency Contact Name/Relationship/Phone *

Do you have any physical limitations? No/Yes (Please Explain) *

Please read and click circle below *

I understand the activity I am planning to undertake is completely voluntary. I agree to limit my participation in yoga, mind-body and movement classes to the level of activity that is comfortable to my situation at the time. I hereby waive Todd Dybul, Yogawerx LLC and its instructors of any liability in case of an accident or injury. “Thiensville Health Alliance" assumes no liability or responsibility for this event”

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