Registration Form and Liability Waiver Ver 0810 Date ______________________________ Name ______________________________________ Date of Birth _______________________________ Address ______________________________________________ City _________________________  State ________________  Zip _______________ Work Phone _______________________________ Home Phone ______________________________ Email ______________________________________ Referred By _____________________________ How did you hear about us? _______________________________________________ What other activities do you participate in? ____________________________________ I, _________________, have been examined by a licensed physician within the past six months and have been found by such physician to be in good physical health and fully able to perform all yoga exercises which I am to learn and perform during my enrollment. I agree to faithfully follow all instructions given me by the instructors as to when, where and how to perform and not to perform yoga exercises it being understood that any deviation by me from such instructions shall be at my own risk. I understand that the tuition paid herewith and such registration fees paid hereafter are non-refundable and non-transferable. I further understand that at the instructor’s discretion, I could be asked to leave the class if found to be disruptive to others.   I, _________________, hereby acknowledge, understand and agree that by taking part in yoga classes at Bikram Yoga Rockville, LLC there is a possibility of physical injury or illness and I am assuming the risk of such illness or injury by participation. Therefore, in consideration of allowing me to participate, and for other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged and agreed, I agree to release and hold harmless Bikram Yoga Rockville, LLC (the “Company”), including its officers, instructors, members, contractors, agents and its personnel from any and all liability (including reasonable attorney’s fees) for any claim whatsoever, including any claim arising out of any injury or illness incurred by me while participating in yoga classes and/or while on the Company’s premises, whether or not caused by the negligence of any of the Company’s members, personnel or contractors. _________________________________________________________________________ _____________  _________________________  ____________________________________          Date        Signature of Participant          Signature of Parent or Guardian (if applicable)