Name____________________________________________________________

Address__________________________________________________________

City______________________________________Zip_____________________

Home Phone________________________Work__________________________

E-Mail___________________________________________________________

Primary Class Choice:

Level_____________ Day______________Time_____________

Known physical limitations ____________________________________________

I hereby stipulate that I am physically sound to proceed with instruction in Yoga. It is further agreed that all exercises and lessons shall be undertaken at my sole risk and that CNY YOGA CENTER shall not be liable for injuries or damages to my person or property arising out of, or connected with, the use of services or facilities of THE CNY YOGA CENTER or the premises in which the same are located. I do hereby forever release and discharge THE CNY YOGA CENTER from all such causes of action.

I also understand my deposit and tuition are non-refundable and neither may be applied toward any future semester.

Amount Enclosed________________Signature___________________________