Artful Movement: Educating Mindfully (Summer Retreat 2024)

...

* These fields are required

Fully booked. Join the waiting list.

First Name *
Last Name *
Email *
Phone
Secondary Phone
Gender
Pronouns	She/her, He/him, They/Them, etc.
Emergency Contact Name and Relationship *	First and last name.
Emergency Contact Phone *	Please give us the best number to reach the Emergency Contact
Name of Student's Physician *
Physician's Phone Number *
Have you practiced yoga before? *
For Classes: Do you have any specific areas you want to work on? *	Balance in body/life De-stressing/relaxing/quieting mind Flexibility Increase energy Strength/posture
Do you have any specific areas you want to work on? (PS)	Abs/core strength Arm Strength Shoulders and neck Back (strengthening/flexibility) Legs (strengthening/hamstrings) Knees Buttocks Hip openers Flexibility Weight reduction Increase energy Balance in body/life De-stressing/relaxing/quieting mind Cleansing/detoxing body Posture/de-slumping Please check all boxes that pertain to your needs.
Physical limitations? *	Do you have any injuries or physical limitations that will impact your ability to participate in class? If you check "yes," you should consult your healthcare provider before engaging in exercise.
Comments for your teacher regarding concerns or limitations	Please describe any physical or personal challenges that you'd like your teacher to know.
Your Goals *	Why do you want to practice yoga now? List how you want to benefit—or what you want to accomplish or learn—in order of importance.
Waiver *	I understand that yoga is a physical discipline that requires a certain amount of mental concentration and physical strength and endurance. As is the case with any physical activity, the risk of injury, even falling, is always present and cannot be entirely eliminated. I agree to work at my own pace and according to my own limitations, including but not limited to listening to my body, adjusting appropriately, and responsively and attentively responding to any pain, discomfort, or injury. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. I affirm that I alone am responsible for deciding whether to practice yoga and I take full responsibility for my safety and well-being. I hereby irrevocably release and waive any claims that I, my heirs, or representatives have now or hereafter against INA Wellness LLC, Create Calm Inc, and their staff and instructors, and affiliate studios and instructors from any liability associated with my participation in any classes, workshops and/or private or group instruction provided. Please check both boxes.
Security check	Type the text shown: