Simply fill out the Registration Form below and click on Submit. Fields marked with an "*" require your response, however, if you have filled out this form after September 1, 2009 and your information has not changed, you can type "Same" in the response box in the fields below your name.

Please make sure you scroll to the bottom of the page to respond to the release and waiver. When you arrive for class, you'll just need to sign your name, pay the fee [Cash or check only] and enter the world of yoga. If you would like to pay with credit card, please do so after you fill out this form, by going to the "Fees and Policies" page.

Today's Date *

Your Name: *

Telephone: Home *

Telephone: Work

Telephone: Cell

Email: *

Address *

City, State, Zip *

Emergency Contact Person's Name and Phone number: *

Injuries: If none, please state "None", otherwise describe briefly *

Illnesses: If none, please state "None", otherwise describe briefly *

Surgeries: If none, please state "None", otherwise describe briefly *

Chronic Conditions: If none, please state "None", otherwise describe briefly *

Medications: If none, please state "None", otherwise describe briefly *

My level is

I would like to register for following Special Event or Workshop: (please specify)

I would like to register for the following Session

Class I want to take

Comments:

I understand that by clicking the submit button, I hereby assume all risk of injury or damage to my person during yoga class at New Planet Yoga, 1150 Burke Street, Winston-Salem, NC 27103 during physical activity, or incidental thereto, howsoever and wherever occurring, and however long the yoga or physical activity may continue, and I hereby release all individual teachers from any and all claims and demands or liabilities for any injury to my person including death or in any way arising out of or incidental to my participation in, or presence during said yoga or physical activity class. I recognize that it is my responsibility to inform the teacher if I am uncomfortable being touched (adjusted) by the instructor when he/she makes corrections during hands-on adjustments that are commonly made during class. If I would prefer not to be touched, I understand that I must make it known by telling the teacher before the class. *
Yes

Registration - This form is for online pre-payments only. Please do not register unless you will be making payment at this time on the Fees and Policies page. The only way to guarantee your space in a class or workshop is by pre-paying.

Yoga: More internal flavors than Ben and Jerry’s!