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Student Information Form

Please complete the form below:

Name(Required)

First Last

Email(Required)

Best Phone

Birth date

Help me to know you better:

Address

Street Address City State / Province / Region ZIP / Postal Code Country

(Your information will not be sold or used for any purpose other than my contacting you about yoga.)

Passion

Occupation

Recent Medical Conditions

Yoga Experience

What You Would Like to Achieve

Consent(Required)

I agree to the statement below.

I hold blameless in the case of accident, injury, or damage of any kind, Abby Lentz, HeartFelt Yoga, LLC, or any students or business location. I recognize that yoga, like many other activities, is potentially dangerous, and I represent that I am a competent person who will act in a safe manner according to the signals from my body. I further recognize that safety is my personal responsibility,
and I agree to participate in a safe manner.

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