Private Yoga Registration

Thank you for your interest in private yoga. Please fill out the intake form. When your form is submitted you will receive an email with available times for your session, as well as an invoice to be paid prior to your session.

Name

First Name

Last Name

Pronouns

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

YYYY

Occupation

What is your experience with yoga and meditation? Please include type, frequency, and duration.

Personal Areas of Interest. Check all that apply.

asana (postures)

pranayama (breathwork)

meditation

other

What are your goals/expectations for your yoga practice? What benefits are you looking to cultivate? All answers are welcome. Consider the following: strength training, flexibility, balance, alternative therapy, weight management, increase well-being, injury rehabilitation, positive reinforcement, stress relief, etc.

Please describe your health history, including any health conditions/concerns I should be aware of?

LIABILITY WAIVER: I understand that in the case where I have an injury, sickness, or anything else that may be affected by physical activity, I have consulted with a physician to ensure I can take yoga classes. I recognize that it is my responsibility to notify the instructor of any serious illness or injury before every yoga class. In further consideration, I knowingly, voluntarily and expressly waive any claim I may have against Amanda Boerboom, Owner of Om Girl Yoga LLC, for injury or damages that I may sustain while participating in the yoga class. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. Please type your name below.

Liability Agreement Confirmation

CANCELLATION POLICY: 24-hours notice is required for cancelling a session. If you have prepaid, you will forfeit a session. If you are paying by session, you will be sent an invoice for the missed session to be paid upon receipt of the invoice. Please type your name below to confirm you agree to the cancellation policy.

REFUND POLICY: Due to the personal nature of this work, refunds will not be given once services have been rendered. If you have paid for the session and you cancel before the 24 hour period, you will receive a refund (excluding the 3% charge for credit card fees). Please type your name below indicating you agree to the terms of the policy.

Available Private Yoga Options

Accessibility

Due to financial needs, I'd like to be considered for the supporter rate of $125/session.

Due to financial needs, I'd like to be considered for the community rate of $100/session.

Payment Options