CHAKRA YOGA Registration Form
First Name
*
Last Name
*
Email
*
Phone
*
Gender
*
Male
Female
Please mention about your current state of health and any treatments you are undergoing for your illness
I understand, acknowledge and appreciate that, as with any physical activity, there is some risk of physical injury and damage associated with my participation in yoga. I represent that I am in good health and suffer from no physical impairment. In consideration of the privilege of participating in the yoga program sponsored by Universal Peace Foundation California, I hereby release, discharge and relinquish Universal Peace Foundation California, and its respective officers and employees, of and from all claims, demands, actions, and causes of action of any sort, for any injuries sustained in connection with my participation in the yoga program. By registering I confirm that I am at least 16 years of age, I agree to the Privacy Policy, and consent to receive updates on upcoming Free/ Sponsored or exclusive yoga & meditation programs from Universal Peace Foundation California. I’m placing my signature below to express sincere desires to learn the yogic techniques/ kundalini meditation. I promise that I will not disclose any meditation/ yogic techniques or other instructions given to me regarding practice procedure to anyone without the written consent of Universal Peace Foundation California.
*
I Accept the above mentioned Terms and Conditions
Waiver *
I agree that photos or videos may be taken of myself at the yoga program and grant to Universal Peace Foundation California, the right in perpetuity to use, store, adapt, enhance, broadcast, communicate, publicly perform and/or display, in any form now known or later developed, photos or videos of myself, as well as my name, quotes or testimonials, throughout the world and/or by incorporating such materials into marketing or advertising materials.
I have read and accept the above release and waiver of liability and fully understand its contents
Photo/ Video
Fee
*
$
150
* 9 Class package, $16 per class
Submit
Email:
info@upfcal.org
Site:
www.upfcal.org
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