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Date
___________
September Session 9/7, 9/14, 9/21 & 10/5
Applicants welcome at any time!
Name
_____________________________________
Baby’s Name
_____________________________________
Address
_________________________________
_________________________________
_________________________________
_________________________________
Phone
Home ________________ Cell ________________
Email
__________________________________________
Known
physical limitations
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Baby's Favorite Song ________________________________________________
Sensitivity
or allergy to massage oils?
Yes
No
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
Tiffany Gallagher and 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 Tiffany Gallagher and CNY Yoga
Center or the premises in which the same are
located.
I do hereby forever release and discharge
Tiffany Gallagher and CNY Yoga Center from all such causes of
action.
I
also understand my deposit and tuition are non-refundable and neither
maybe applied
toward any future semester.
Cost $52/ 4weeks
*$45 of CNY Yoga Member, additional
weeks available at $15.00 a week.
Amount Enclosed ____________
Signature __________________________
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