REGISTRATION FORM
To enroll in classes and workshops, type in the information below, then print and mail this registration form along with your check (payable to Portland Yoga Studio) to:

PYS, 18 Farm Hill Road, Cape Elizabeth, Maine 04107

Please send full payment for your class or workshop. You may then presume that you are registered unless you hear otherwise. Negotiable payment plan and a limited number of work study scholarships are available by calling 799-0054. Questions? Call 799-0054.


HOW DID YOU HEAR ABOUT US?
family friend co-worker
web phonebook flier
brochure...where?
newspaper...which one?
other:

Please complete the following. If you have registered before, please just note any changes to your information. Thank you!

Today's Date:
Name:
Occupation/Profession:
Street Address:
City, State, Zip:
Phone: Home:
Work:
Email:

Brochures will always be available for you to pick up at our Studios. PLEASE CHECK IF YOU:
No longer want to receive our brochure in the mail.
NOTE: We reserve the right to cancel classes, workshops or events if there is insufficient enrollment.

CLASS AND/OR WORKSHOP SELECTION(s)
Day
Time
Level
Instructor
Title
# wks
Reason for
discount *
Cost
TOTAL ENCLOSED $


* REASON FOR DISCOUNT (One discount per person)
Please choose the number of the following category which applies to you. Discounts are available for classes only, not for workshops.

10% discount available if signing up for at least 10 classes:

1- full time university students
2- people who are 65 and better
3- members of the same immediate family, i.e. household. Write names below.
4- 3 or more people of the same workplace within the same session. Write names below
5- any student who recruits one person new to PYS who registers for a term of 10 or more classes. Write their names below.
6- student taking 2 classes/wk @ $10.80 a class (See the Fees & Policies page for more discounts)

For options 3, 4, 5: Write names of other students:

1.
2.

Informed Consent and Waiver of Liability
I understand that yoga can be physically intensive and I voluntarily assume the risk inherent in my participation in classes at Portland Yoga Studio, including the risk of injury, accident, death, loss, cost or damage to my person or property, and I release and indemnify Portland Yoga Studios from and against any and all such claims and liabilities, including attorneys' fees.

I further attest that I am in sufficient physical health, and/or that I have consulted with a physician and I am able to undertake and engage in the physical movements and exercises in classes that I have chosen to take at Portland Yoga Studios. I assume responsibility to update Portland Yoga Studio of any changes in my medical condition that might affect my safety or participation in classes at Portland Yoga Studios.

Signature _________________________________________________ Date _________
That's it! Now print this completed form and mail it with your complete payment to the address at the top of the page.