Surya Shakti Registration Form Name * First Name Last Name Age * Gender * Male Female Prefer Not to Say Gender Pronouns * He/His She/Her They/Them Email * Phone * Country (###) ### #### Location * What city are you located in? Have you taken any Isha programs before? If yes, which ones and when? How regularly do you do the practices? * Any medical conditions or taking medications (Eg. hernia, neck or back disease, dislocations, joint replacements, injury, depression, anxiety, etc.) If yes, please explain. * Have you had any surgeries in the last 6 months? Yes No For women, are you currently pregnant or planning for pregnancy? Yes No Not Applicable History of alcohol, smoking, or substance use? If yes, please explain. Are you comfortable with sitting cross-legged on the floor? * The nature of the program is such that you will be required to be seated cross-legged for extended periods of time, about 30 minutes at a stretch. Yes No Is there anything else about you that you think we should know? We ask that you try to answer all the health-related questions as truthfully as possible. This will help us make any arrangements to ensure you have a smooth experience. Standard Legal Disclaimer and Waiver - 100 Percent Yoga assumes no responsibility or liability for any injuries or losses that may result from practicing yoga or any other exercise program. Always consult your health care provider and obtain full medical clearance before practicing yoga or any other exercise program. By selecting 'I Agree', you confirm understanding that yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I understand respectfully that the contents of the class including the practices learnt are the intellectual property of the Isha School of Hatha Yoga. I will treat the knowledge gained from the program with the necessary sanctity and I will not attempt to teach anyone else. I relinquish all rights to any photographic/video record of this class that may be created and give permission to 100 Percent Yoga and/or Isha Foundation to use such photographic/video material for promotional purposes as long as such material is in good taste and meets community standards for decency and appropriateness.* * I agree Thank you for your interest in signing up for the upcoming Hatha Yoga Workshop. We will go over your form and get back to you shortly on the next steps to complete your registration process.
