still water yoga    -    registration & health history form
use the PRINT button on your browser to print this form back to calendar
Name Address
Phone (H) City StateZip
Phone (W) Email
List the class(es) and event(s) you are registering for below. See calendar for complete schedule. See costs per session.

winter
january 4 - february 27
8 weeks
Class Day Time







spring l
february 28 - may 1
8 weeks. studio closed 3/14 - 3/20.
Class Day Time







Special events
See calendar for cost per event.
Event
 Date
 Cost










Total enclosed:

Payment and refund policy: payment due in full prior to first class. $30 of registration fee is a non-refundable deposit to reserve a space. no refund after first class. No one will be turned away due to financial hardship.
Make-up policy: missed classes must be made up within the same session by taking any similar level class.

Waiver: I understand the activity I am planning to undertake is entirely voluntary. I release Still Water Yoga Studio, and all instructors and independent contractors from any liability in event of injury. I undertand it is solely my responsibility to disclose any prior existing health conditions. It is my responsibility to discuss exercise with my physician. I have read the refund policy.

Signature Date

If you are a new student, or your health history has changed, please complete this health form. Use back of form if more space is needed.
Person to contact in case of emergency
Name Phone

Precautions: There are some medical restrictions. Please advise your teacher before class of any significant health problems (i.e. hypertension, thyroid disease, spinal injury) or if you are pregnant or presently menstruating. Adaptations can be made. Yoga is not a substitute for medical counsel. If in doubt about your present physical condition, consult your health care provider before taking this or any exercise program.

Are you under a doctor's care?
If yes, briefly explain

If you are you under a doctor's care, have you been okayed to take yoga?

Are you on medication?
If yes, for what?

Have you a new injury?
If yes, what?

Have you an old injury that continues to give you problems?   If yes, briefly describe


Do you regularly stretch?

How did you hear about still water yoga?

Tell us what you do for a living.

It would be helpful to the teachers to know your age.

Thank you for taking the time to complete this form. It allows me to personalize your practice to your particular uniqueness.     amy hawks and staff
please make check payable to still water yoga and mail with registration and signed waiver to:
still water yoga
5895 omaha avenue, suite 4
stillwater, mn 55082