New Member Form (for print)

Name _____________________________________ Birthday ____/____/_____

Address _________________________________________________________

City ______________________________ State _______ Zip ______________

Email address______________________________________

May we send you notices about schedule updates, events, etc.?     Yes / No


Cell # (______)____________________

Home # (______)________________Ext (_____) Work# (_____)_____________

How did you find out about us? (Circle One)

Internet   Driving By    Advertisement      Mailing     North Park News

Postcard      Friend: ______________ Other: _________________

EMERGENCY CONTACT :

Name _______________________________________

Relationship _________________________ Phone ___________________

What is your current exercise/fitness routine?____________________________

__________________________________________Frequency:_____________

Do you have any injuries or recent surgery?

________________________________________________________________________
Release of liability - In signing below that ginseng Yoga & Bodywork is in no way responsible for the safekeeping of my personal belongings while I attend class. I understand that classes at ginseng may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personalinjury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against ginseng or its members for any personal injury,
property damage/loss, or wrongful death, whether caused by negligence or otherwise.

Please Sign Here x__________________________________ Today's Date: __________