Pre-Registration and Pre-Payment is
required!
Mail Form & Payment to:The Yoga Generation LLC
1632 Rt. 38 Suite C Lumberton N.J. 08048
Att: Mary H Szidloski (609) 518-9642
(YOGA)
Email: BeingYoga@Yahoo.com
_____________________________________________________________________________________________________________________
The Yoga Generation
Registration Form
Class Name: ____________________Time: _________ Start Date:_______Location:_____________
Name:
____________________________________________________________________________________________________________
Address:
_______________________________________________________________________________________
Email:
___________________________________________________________ Phone # _____________________
Amount
Paid $ _______________ Check #___________________ Date: ____________
I certify the above named applicant(s)
emotionally ready: in good health with my permission to participate in this
program. I understand that participation in any physical activity involves
inherent risk and that even when safety precautions are utilized, injuries can
occur. I hereby release The Yoga Generation LLC, Ever-Fit Physical Therapy and Westampton, Mt.Holly,
Eastampton, Lumbertom Recreation Departments their employees, agents, staff and contractors
from any and all claims, including bodily injury and or illness in connection
with this program.
Signature:________________________________________________
Date: _______________
