Details of Health History
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Please share details of primary diagnosis, past surgeries, medication and health concerns, etc.
What do you hope to achieve by participating in our program?
Please share with us details about your child's health and development:
Signature
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Terms & Conditions:
I hereby agree to the following terms and conditions for YAMA Foundation | Hersha Yoga, stated below:
I understand that it is my responsibility to consult with a medical professional prior to and regarding my (or my child’s) participation is the class / workshop / program. I understand that it is my responsibility to determine whether I (or my child) can practice any yoga postures and participate at my own risk.
Where relevant, I agree to share crucial information such as medical reports, letters, evaluations by teachers, doctors and/or therapists with the instructor(s) to help determine the appropriate approach for me (or my child.)
As a student, I agree to go at my own pace and avoid straining my body. I understand that all students are free to skip any posture or end any posture early. I will not hold the instructor(s) responsible for any injury during or arising from my (or my child’s) participation in this class / workshop / program.
I agree to exercise reasonable and sensible caution for my (or my child’s) wellbeing while practising yoga under any circumstances, whether inside or at an exterior location. I understand that I am responsible for my own personal property.
I agree to pay the appropriate fees on time regarding my (or my child’s) participation.
Waiver of Liability:
In further consideration of me (or my child) being permitted to participate in the class / workshop / program, I knowingly, voluntarily and expressly waive any claim I may have against Hersha Chellaram, YAMA Foundation | Hersha Yoga, instructors, assisting staff, sponsors of event, affiliate organisations or sponsoring location for any injury or damages or death that may be sustained as a result of my (or my child’s) participation in this program.
I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue for any injury or death caused by their negligence or other acts.
Photo Release:
Permission to use photographs/video/recordings of all activities related to the YAMA Foundation | Hersha Yoga.
I grant to YAMA Foundation | Hersha Yoga, its representatives and employees the right to take photographs of me (or my child) and my property in connection with the above-identified subject. I authorise the YAMA Foundation | Hersha Yoga, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that the YAMA Foundation | Hersha Yoga may use such photographs of me (or my child) with or without my (or my child’s) name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above.
Personal Information Collection Statement:
Please note that YAMA Foundation | Hersha Yoga collects your personal information through your submission of this Registration Form.
For us to process your registration and provide information and services, we will require you to provide your personal information to us. This applies to both existing and potential students. YAMA Foundation | Hersha Yoga will use your personal information for registration, for provision of services and for marketing & promotional and membership purposes. Please note that failure to provide sufficient personal information as requested in the mandatory fields on this Registration Form will render us unable to provide your requested services.
Personal information held by YAMA Foundation | Hersha Yoga will be kept confidential but we may provide such data to our contractors or third-party service providers who process applications & orders and provide mailing services, marketing support & research activities on our behalf. To enable their execution of the above services, we will need to provide them with access to personal information on a minimum need-to-know basis. However we will impose the strictest requirements of security and confidentiality on their data handling. They will not be permitted to use the personal information for anything else other than providing the required services set out above.
Unless we have informed you beforehand and have obtained your authorisation, or are obliged to do so by law and regulatory authorities, we will not under any circumstances disclose your personal information.
According to Personal Data (Privacy) Ordinance, you have the right:
- to check whether we hold personal data about you and - to access such data;
- to require us to correct inaccurate data;
to ascertain our policies and practices in relation to personal data and the kind of personal data held by us.
Please send requests to access or correct date, to cease communications, and questions or complaints to: info@hershayoga.com
