Client Intake

Please complete the form below

Name

First Name

Last Name

Phone

(###)

###

####

Birthdate

MM

DD

YYYY

Email

Address

Emergency Contact

Relationship

Please describe your experience (if any) with yoga.

What brought you to private yoga sessions and what are your goals?

Please describe any other current physical activity.

Please describe any current/previous health conditions.

Release and Acknowledgement

Client certifies that he/she is of adequate physical condition to participate in physical exercise.

Client certifies that he/she assumes the risk of physical injury, whether minor, severe, or otherwise.

Client certifies that he/she will disclose to Trainer whenever suggested activities cause distress beyond Client’s threshold.

Client certifies that he/she will not hold Vo Han and its instructors liable for any physical injury, whether minor, severe, or otherwise that result from Training Sessions.

Client certifies that he/she assumes all responsibility for his/her participation in the Training Sessions.

Client Signature

By typing my name below, I acknowledge that this serves as my electronic signature, signifying my agreement to all of the above terms.