Registration Form
To secure your place in a class or workshop:
Call Ann (207-751-9589).
To register for a class:
Print and complete this form.
Mail/bring your check, payable to Ann Flannery
How did you hear about Ann?
Family Friend Co-worker Web Phone book
Flier (where?)___________________ Other__________________________
If you’ve registered before, please note any changes. Thank you.
Today’s date ________________________________________________________________________
Name ________________________________________________________________________________
Street address ________________________________________________________________________
City, State, Zip ________________________________________________________________________
Phone: home- _________________________________________________________________________
work- ________________________________________________________________________________
cell- ___________________________________________________________________________________
e-mail _________________________________________________________________________________
Class or workshop selection:
Day Time Class Instructor #of Weeks Cost (12 weeks $144/ $16 drop in)
________________________________________________________________________________________________________________________________
Informed consent and Waiver of Liability:
The practice of yoga includes physical exercise and a risk of injury. It is advisable to consult your physician before embarking on any exercise instruction. As professional level yoga instructors we are responsible for providing you with competent yoga instruction. We are not responsible for safety beyond providing competent instruction. Your signature below releases Ann Flannery and any other instructors from any and all liability for injuries that are not directly and proximately caused by our professional negligence. I have read, understand and agree to the content of this professional Disclosure Form and Release.
Signature______________________________________________________________________________Date______________________________________________
To secure your place in a class or workshop:
Call Ann (207-751-9589).
To register for a class:
Print and complete this form.
Mail/bring your check, payable to Ann Flannery
How did you hear about Ann?
Family Friend Co-worker Web Phone book
Flier (where?)___________________ Other__________________________
If you’ve registered before, please note any changes. Thank you.
Today’s date ________________________________________________________________________
Name ________________________________________________________________________________
Street address ________________________________________________________________________
City, State, Zip ________________________________________________________________________
Phone: home- _________________________________________________________________________
work- ________________________________________________________________________________
cell- ___________________________________________________________________________________
e-mail _________________________________________________________________________________
Class or workshop selection:
Day Time Class Instructor #of Weeks Cost (12 weeks $144/ $16 drop in)
________________________________________________________________________________________________________________________________
Informed consent and Waiver of Liability:
The practice of yoga includes physical exercise and a risk of injury. It is advisable to consult your physician before embarking on any exercise instruction. As professional level yoga instructors we are responsible for providing you with competent yoga instruction. We are not responsible for safety beyond providing competent instruction. Your signature below releases Ann Flannery and any other instructors from any and all liability for injuries that are not directly and proximately caused by our professional negligence. I have read, understand and agree to the content of this professional Disclosure Form and Release.
Signature______________________________________________________________________________Date______________________________________________