Henna Yoga Lej

Bookings: ecoartmag@gmail.com 407-901-6630 +1 876 543-9442 Ecological Henna Artist Muralist & FineArt Curator Youth Integrated Restorative Yoga Instructor

New Student Registration Form Name*________________________________________________________________________ First Last Address* Street Address _________________________________________________________ City ______________________________________ Region______________________________ Country________________________________Phone*_________________________________ Email*________________________________________________________________________ Emergency Contact Name*_______________________________________________________ Emergency Contact Phone Number*________________________________________________ Date:______________________________Time:________________Duration: 60 min / 90 min How did you find out about Henna Yoga Lej? 

Family/Friends

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Social Media

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Local Business Flyer

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Internet

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Search Engine

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Other

Which Henna Yoga Lej class and session options are you primarily interested in?* 

10-day Unlimited Introductory Offer $50 

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Unlimited Monthly membership $180

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Private session: $25- $35

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Promo class: $8 (60min)

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Private session for couple: $60

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Group class: $13 -$20

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Henna Aromatherapy: $20- $40

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Five class pass: $70

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Yoga Workshop/Course/Event/MiniRetreat: Price Varies

Ten class pass: $120

* The ‘14-day Introductory Offer’ can be used at any time, but only once per person. **Monthly memberships expire at the end of each calendar month. ~ 5-Class passes are valid for 5 weeks and 10-class passes are valid for 10 weeks. Class passes are non-refundable and non-transferable and can be extended only due to serious illness with medical certificate, permission must be requested in writing. Class passes will be automatically extended to reflect any studio closures or cancellations. It is essential to book into any given class to secure a place. If a cancellation is made with less than 36 hours notice prior to the scheduled class or a failure to show, a grace is given on the first occasion, but repeated late cancellations or no-shows will result paying the cost of the class. Prices are subject to change. 50% deposit prior to confirm booking. 10% is added for rescheduling and late confirmation after 48 hours.

Please tick all relevant health history 

Asthma

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High blood pressure*

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Sedentary lifestyle

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Arthritis

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Dizziness*

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Joint problems

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Neck/Back problems

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Epilepsy

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Smoker

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Shortness of breath

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Low blood pressure

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Eye problems

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Stroke

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Overweight

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Heart condition*

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Diabetes

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Chest pain*

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Bone/Joint damage*

Please Note: If you answer yes to any of the above marked with an asterix *, a note from your health practitioner allowing you to participate in any yoga or fitness related activity is mandatory. You are not permitted to attend a Henna Yoga Lej class until clearance is obtained. If you ticked any of the above, please provide further details ________________________________________________________________________________________________ ________________________________________________________________________________________________

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Does your family have a history of any of the conditions above? Yes

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No

________________________________________________________________________________________________ ________________________________________________________________________________________________

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Are you pregnant, or have you given birth in the last six months? Yes

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No

If yes, please provide details: ________________________________________________________________________________________________ ________________________________________________________________________________________________

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Are you taking any medication that will affect your physical performance? Yes

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No

If yes, please provide details: ________________________________________________________________________________________________ ________________________________________________________________________________________________

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Do have any injuries or recent surgeries that may restrict your yoga practice? Yes

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No

If yes, please provide details: ________________________________________________________________________________________________ ________________________________________________________________________________________________

Are there any other medical conditions, physical restrictions or special considerations Lisa should know of? Yes

No

If yes, please provide details: ________________________________________________________________________________________________ ________________________________________________________________________________________________

Help Lisa tailor this class to fit you better: Have you practiced Yoga before? If yes, what type and for how long? ________________________________________________________________________________________________ ________________________________________________________________________________________________

Are you currently involved in a regular fitness program?

________________________________________________________________________________________________ ________________________________________________________________________________________________

What do you wish to learn or achieve from your HENNA YOGA LEJ practice? ________________________________________________________________________________________________ ________________________________________________________________________________________________

Informed Consent: HENNA YOGA LEJ recommends that health approval be obtained before beginning an exercise program. 

I understand that HENNA YOGA LEJ will not be held responsible for any neglect on my behalf to seek medical approval prior to commencing a Yoga practice. I also understand that classes taught at HENNA YOGA LEJ are not meant to replace any form of medication or medical treatment that I am currently seeking now or in the future.

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I have been informed and understand that strength, flexibility and cardio vascular exercise, including Yoga, are potentially hazardous activities. I also have been informed and understand that these activities involve a risk of injury and that I am voluntarily participating in these activities with full knowledge and appreciation of the dangers involved.

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I have read, understand and agree to follow the HENNA YOGA LEJ studio etiquette, policies and procedures as well as the conditions of classes.

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I understand that it is essential to book into any given class to secure a place. If I then cancel with less than 36 hours notice prior to the scheduled class or fail to show I will be given grace on the first occasion, but repeated late cancellations or no-shows will result in my paying the cost of the class.

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I declare all of the information provided by me to be correct to my knowledge and have not withheld any information that may result in any consequences.

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I agree to advise Lisa Lej of Henna Yoga Lej in writing if any of the information provided by me changes.

Agree to the informed consent and booking terms and conditions* I agree

You may indicate on the form above whether or not you would like to receive henna after you yoga session as a way of locking in positive affirmations for total relaxation. This is a way of embracing selflove throughout your life. Henna is 100% natural and last 2-3 weeks depending on skin type and activities. Henna is also good or treating nails for strong and healthy long nails. You also have the option of washable stainless Henna Aromatherapy. Handpicked henna herbs directly from Hare Krishna Temple, Juhu Beach, Bombay, India .

Thank you for your support and see you soon!

Namaste 

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