Registration Form Online Zoom Series Client's Full Name* First Last Date* MM slash DD slash YYYY Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please list any medical alert/injuries*Emergency Contact* Phone* Yes, sign me up to receive more information about what Laurel has coming up. Please click to accept the above terms* I understand and accept THIS AGREEMENT is made and entered between Laurel Attanasio and client below. WHEREAS Laurel Attanasio and client wish to enter into this agreement in order to define their respective rights, duties and obligations. NOW THEREFORE in consideration of the terms, covenants, conditions and mutual promises contained herein, and other good and valuable consideration, it is hereby stipulated and agreed as follows: 1. Laurel Attanasio will provide yoga, stand up paddle board lessons and fitness classes. I am aware that Laurel Attanasio, yoga/Pilates/Stand Up Paddle Board (SUP) Yoga/Fitness instructor, is here to serve me by sharing the knowledge of yoga, SUP, Pilates & Fitness. I understand that the practice of these exercises involves physical movement and exercise which may from time to time be strenuous, and that such practice carries some risk of injury. I also understand that I must judge my own capabilities with respect to my participation. By my participating in classes or activities with Laurel Attanasio, I agree to take full responsibility for not exceeding my limits in the practice of these exercises for any injury I might suffer. I also acknowledge that it is my responsibility to ascertain that there is no medical reason to prevent my participation in the classes with Laurel Attanasio. I also acknowledge that it is my responsibility to inform Laurel Attanasio immediately if an injury occurs during class. I understand that, from time to time during classes Laurel Attanasio may physically adjust your form in postures. If I do not want such physical adjustments, I will so inform Laurel Attanasio. I also acknowledge that if I do wish to receive such physical adjustments, I hereby waive and release any claim that I might have at any time for injury of any sort against Laurel Attanasio in any way involved therewith. By completing the following form, the undersigned stipulate and agree that they have completely read this agreement, that the terms are fully understood and voluntarily accepted by both parties and that this agreement is not signed under duress.