Yogawerx LLC mind-body arts
Mindful Yoga Registration Form
Summer Session 2019
6 Tuesdays, 5:30-6:30 p.m.
5/21, 5/28, 6/4, 6/11, 6/18, 6/25.
: Thiensville Health Alliance, 136 N. Main St., 3rd Floor (Indaba Room), Thiensville***
Instructor: Todd Dybul (Min-9 | Max-20 participants)
Questions? Please contact firstname.lastname@example.org or 262-613-2385
Thank you and we'll see you at our first class! Todd
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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”
"Yoga therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the philosophy and practice of Yoga."
~International Association of Yoga Therapy