Intake Form — the open method

Relax & Lengthen Class Intake Form

*= required field

Name

First Name

Last Name

Email Address

Address

note: Address 2 = unit or apartment number

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

How did you hear about this class?

What are your goals for this class?

Do you have difficulty with any positions, such as being on your knees, arm raises, etc.? (Please specify)

Important: Please tell Margi if you need an alternative stretch or position, during or after class to customize your comfort level.

Do you have any previous experience with stretching classes or yoga; and if so - is there anything that you particularly did like or that didn't work for you?

Do you have any physical/medical conditions or injuries that limit your physical activity? (Please specify)

Do you have any challenges with your hearing?

Do you have Osteopenia or Osteoporosis? Please specify and advise of any new diagnosis.

Is there anything else you'd like to add?

By clicking here I agree to the following: I understand that Relax & Lengthen is a physical exercise and I am responsible for my decision to practice it. I accept all responsibility for my health and any resultant injury or mishap that may affect my wellbeing or health in any way. I hereby agree to irrevocably release and hold harmless of any responsibility the class instructor, Margi Green, and the staff and owners of the 222 CommunityWellness Center.

I agree

By clicking here I agree to the following: Cancellation Policy: 24 hours are required to ensure you will be refunded for the class. Please note that cancellations under the 24 hour period will only be refunded if we are able to fill your cancelled spot with another student.

I agree

date

* = required