Please fill out registration form and click the register button at the bottom of the form. All fields with an asterisk are required. For further details about classes, please refer to Class Guide.
Please note that you are officially registered when your payment has been received. Make checks payable to Andrea Smith and mail payment to:
Andrea Smith, PO Box 6744 Ithaca, NY 14851* Prior Yoga Experience:
* What do you hope to gain and how do you hope to benefit from your practice of yoga?
Do you have any special health concerns or physical limitations that you would like for me to know about?
How would you describe the state of your physical health?
* Agreement of Self Responsibility
These yoga classes are offered with the intention to help promote increased physical, mental, and emotional health and well-being. You are encouraged to always pay attention to your body's sensations and wisdom and not to strain or push beyond what feels balancing and supportive to you on a given day. I encourage you to share any concerns or questions you may have with me about your yoga experience.
By typing my name into the box below on this email form, I certify that I have read the above information and that I agree to take full responsibility for my participation in yoga classes with Andrea Smith. I will not hold Andrea Smith, any of her colleagues at Cayuga Heights Center for Wellness &
Healing Arts, any of her colleagues at Sunrise Yoga Center, or any instructors she may employ to assist her to be liable in any way for any injuries or mishaps that may arise from my participation in her yoga classes.
Electronic Signature (Please type full name below):
Where did you hear about this class?:
© 2003 Yoga with Andrea Smith
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