PRENATAL, POSTNATAL, BABY & ME REGISTRATION FORM
Level of Activity:
Sedentary Light Medium Heavy Very Heavy
Do you have a history of the same problem(s)?
What makes it better?
What makes it worse?
What self-help measures have you tried? Did they help?
How did you hear about the Prenatal Yoga Center? (please check all that apply)
Due Date: Dr./Midwife:
Number of pregnancies (including this one): Number of deliveries:
POSTNATAL AND BABY & ME:
Baby's Date of Birth:
Policies and Guidelines
The Prenatal Yoga Center honors and respects the journey of pregnancy and new motherhood. With that in mind, we have created guidelines and policies that offer flexibility while maintaining the integrity and intention of our yoga program and other professional services. We appreciate your understanding and observance of our guidelines and policies and look forward to serving you.
- Prenatal, Postnatal and Baby & Me and Infant Massage classes are ongoing; you may start at any time.
- Class cards are valid for a limited penod of time. Prenatal Yoga cards are valid for 10 consecutive weeks (70 days). Postnatal and Baby & Me are valid for 6 months.
- Classes that are not used by the expiration date are forfeited A one-time two-week extension can be purchased upon request.
- Class cards have no cash value.
- Class card holders not given preferential treatment. AU classes first come, first served. Latecomers admitted at teacher's discretion.
- All fees once paid are non-refundable.
I understand that 8-class packages are valid for 10 weeks:
MONTHLY CLASS CARDS & PYC PASS
- Valid for 31 consecutive days, OR for the duration of the contract period
- PYC Pass requires a two 2-month minimum commitment, mcluding a signed contract and a vahd credit card on file for auto-pay.
MAKE UP CLASSES & BED REST
Should you deliver within your package, unused classes (class cards) or unused time (monthly passes) will be credited towards Baby and Me or Postnatal Yoga classes to be used wrthm 6 months. Unused classes will NOT be carried over to another pregnancy, nor can they be transferred to another student.
With the exception of bed rest accompanied by a doctor's note. the Prenatal Yoga Center cannot be responsible for providing additional make-ups or issuing any credit for classes missed as a result of scheduling conflicts, vacations, illness, emergencies, or other circumstances beyond our control. If you are put on bed rest, please notify the studio immediately and rememmq classes w1fl be transferred to Baby and Me or Postnatal Yoga
AGREEMENTS of RELEASE and WAIVER of LIABILITY
- I am or will be participating in the Yoga Classes, Health Programs or Workshops offered by the Prenatal Yoga Center, LLC, during which I will receive information and instruction about yoga and health. These classes entail physical activity. I recognize that such physical activity may be difficult and may cause or aggravate a physical injury or medical condition. I am fully aware of and accept the risks and hazards involved.
- I understand that it is my responsibthty to consult with a physician prior to and regarding my participating in the Yoga Classes, Health Programs or Workshops, and to receive prior approval to participate. I represent and warrant that I am physically fit and I have no Medical condition or injury which would prevent my full participation in the Yoga Classes, Health Programs, or Workshops.
- In consideration of being permitted to partrcipete in the Yoga Classes, Health Programs or Workshops, I agree to assume all full responsibility for any risks, conditions, injunes. or damages, known or unknown, which I might incur or aggravate as a result of my participating in same.
- In further consideration of being permitted to participate in the Yoga Classes, Health Programs or Workshops (the "Programs"), I knowingly, voluntarily, and expressly waive any claim I may have or acquire against the Prenatal Yoga Center, LLC, or the landlord or any premises at which it may operate, for any injury, condition or damages that I may sustain as a result of entering or being on the premises or participating in the Programs
- I, my heirs or legal representatives forever release, waive, discharge, and covenant not to sue the Prenatal Yoga Center, LLC or the Landlord of any premises at wtuch it may operate, for any mjury, condition, or death which arises, is caused by oris aggravated by reason of my participation in the Programs.
- I give permission for my image (e.g. photograph, video), and/or a sound recording of me, to be used by the Prenatal Yoga Center, and those acting with the authority and permission of the Prenatal Yoga Center, in promotional and media materials. These materials include, but are not limited to, brochures, websites and television/radio coverage, and in any media now or hereafter known. The Prenatal Yoga Center has the irrevocable, perpetual and unrestricted right and permission to take, use, re-use, publish and republish my image and/or sound recording in such materials. I also consent to the use of any published matter in conjunction with such image and/or sound recording. I also waive any right that I may have to inspect or approve the finished product or products. I release, discharge and agree to hold harmless the Prenatal Yoga Center, its legal representatives or assigns, and all persons acting under rts permission or authority or those for whom it is acting, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture, production of any video footage or voice recording, or in any subsequent processing thereof, as well as any publication thereof. I warrant that I am of full age. I state further that I have read the above authorization release and agreement, and that I am fully familiar with its contents.
- I understand that it is my continuing responsibility to inform the Prenatal Yoga Center LLC of any previous medical conditions, mjuries or surgeries prior to my first class and at such other times as ! acqurre information to the same.
- The tuition paid herewith and such registration fees paid hereafter are non-refundable, such refunds, if any, as are made shall be entirely within the discretion of the Prenatal Yoga Center, LLC.
Please list any previous conditions, ailments, injuries and/or surgeries:
- I also understand that except for a monetary refund, I have no claims against the Prenatal Yoga Center, LLC, or the landlord of the premises (except for monetary refund) by reason of their refusal to allow me to participate in the Programs.
I have read the above Release and Waiver of Liability and fully understand its contents. I voluntarily agree to the tenns and conditions as stated above.