East to West Yoga and Pilates

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	Studio Address 1446 Bloor St. W. Toronto, Ontario Canada M6P 3L5 P: (416) 588-3568 F: (416) 588-0370 Contact Email: Susie

Registration Form

	Fill in information below, print, and fax or mail with payment.
	Name
First Name:
Last Name:
	Mailing Address
Address:
City:
Province:
Postal Code:
	Contact Information
Email:
Phone:
Cell Phone:
	Course Information
Course Name:
Course Date:
Course Location:
	Payment Information
Payment Method:
Cardholder:
Card Number:
Expiry:
Signature:
	RISK WAIVER & CONSENT FORM I recognize that risk of injury or potential health risk may be involved in participation in the above-named program/activity. I hereby willingly assume such risk of injury or health risk for myself and my participation in the program/activity. In consideration of the acceptance of my application and permission to participate in the program/activity, I for myself, my heirs, executors, administrators, successors and assigns, HEREBY RELEASE, WAIVE, WAIVE AND FOREVER DISCHARGE East to West Yoga, all other organizations, associations and companies associated with any of the programs offered by East to West Yoga, and all their respective agents, employees, officials, servants, contractors, representatives, elected and appointed officials, successors and assigns OF AND FROM ALL claims, demands, damage costs and actions whatsoever and however caused, arising to or to arise by reason of my participation in the program or any of its associated activities. Signature: ____________________________________________________ Cancellation Policy: Refunds are only given in the rare case of course cancellation due to low enrollment, or in documented emergencies in which case a $25.00 administration fee will apply; otherwise, if you can't attend a course you will be given a credit for a future course of your choice.