New Student Registration Form

Helpful Information about Lake Center Yoga

Name(Required)

First Last

Address

Street Address City State ZIP Code

Email(Required)

Best Phone Number(Required)

Name of Emergency Contact(Required)

First Last

Emergency Contact Phone Number(Required)

Have you practiced yoga and if so how long & what style?(Required)

Which class would you like to attend first?(Required)

How did you hear about Lake Center Yoga?

What health concerns do you have?

Astrological Information (optional)

Date of Birth

Time of Birth - (be exact, include AM or PM) if you don't know leave blank and if you find out let us know. (If unknown, please enter N/A)(Required)

Location (Optional)

Untitled(Required)

Agree that all classes I have paid for have to be completed during the current 6 week session.

Sign Here(Required)

Date of Signature