Mindful Yoga Registration

Mindful Yoga Registration Form

Winter Session 2019
6 Tuesdays, 5:30-6:30 p.m.
Dates: January 15, 22, 29 and February 5, 12, 19.
Location: Mequon Dance Studios, 217 N. Main St., Thiensville
Fee: $70.00
Instructor: Todd Dybul (Min-9 | Max-25 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 *

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Last

Email *

Phone *

Address *

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City

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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. “Mequon Dance Studios assumes no liability or responsibility for this event”

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