Name

First Name

Last Name

Email Address

Phone

For class cancellations and communications between classes.

(###)

###

####

Occupation

How did you hear about Ki to Kaizen Yoga?

Typical preferred day(s) & time(s) to meet

Have you practiced yoga before?

Home & Studio practice both count!

yes

What does a typical week look like for you?

Please describe any workout routine, workload, recreation, family obligations, scheduling...

Physically, please describe how you feel on a daily basis

Mentally & Emotionally, please describe how you feel on a daily basis.

(i.e. stressed, overwhelmed, anxious, frazzled, grounded, calm, energized)

Where in your body do you feel like you hold the most tension?

What are you hoping to gain, discover or achieve through your session(s)

Please be as detailed as possible. Thank you for your time!

I am interested in:

Please check all that apply

Private Classes

Small Group Classes

Eat Breathe Thrive

Online Classes

Ki to Kaizen Yoga Release & Waiver of Liability*

• I understand and appreciate the physical risks involved in a yoga practice and voluntarily assume any and all risks • I am in proper physical condition to participate in this class or event • I agree to release and forever discharge Lara Scriba & Ki to Kaizen Yoga from any and all liability for any injury • I understand that if I am unable to keep my scheduled private lesson appointment, I must offer the courtesy of 24 hours advanced notice via phone call or text • If I offer less than 24 hours advance notice, I may be charged up to half the price of the lesson • Same day cancellations will result in full payment

I agree

YES

Digital Signature

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