Yoga Dicha Studio REGISTER FOR CLASS Please submit the following info below to register for class and/or pay online. Please choose which class you are registering for*Monday 9am LunesMonday 7pm LunesTuesday 9am MartesTuesday 7pm MartesWed 9am MierWed 7pm MierThurs 9am JeuvesThurs 7pm JeuvesFriday 9am ViernesFriday 7pm ViernesSaturday 9am SabadoSunday 9am DomingoSunday 7pm Domingo*if buying a class package, please just chose the first class that you will be attendingDate of class you are attending*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*date / month / yearName* First Last PhoneEmail* Where are you visiting from? City How did you hear about our studio?* found you google search walking by friend referral social media Do you have any injuries or anything we should be aware of?* No Yes Nothing that will effect my practice If you marked yes, please let us know what we need to be aware of*please let your teacher know if your are pregnant or if there are any challenges or injuries they should be aware ofConsent & waiver*I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages, which may incur through participation. I understand that it is my responsibility to consult a physician prior to participating in classes offered at Yoga Dicha STUDIO (YD) located in Tulum, Mexico. I warrant that I have no detrimental medical conditions. I also understand that, individually and on behalf of my heirs, assigns, personal representatives or any other associated party (“Relatives”), I agree to release, acquit and forever discharge Yoga Dicha Studio and / or its employees, agents, officers, representatives, all other related persons or entities, the owner of the premises, etc. (“YD and Others”), from any and all liability whatsoever resulting from any damages, losses or injuries (including death) that might arise in any way out my activities. Personal property: is entirely my responsibility; YD and Others have no liability for loss or damage. Photos and videos: I give permission for YD to use any photos or videos taken in class Acknowledgement By voluntarily and knowingly signing below / electronically agreeing, I am acknowledging that, among other things: I have carefully read this entire release and waiver, understand its terms without reservation and, accordingly, my Relatives and I are waiving substantial legal rights. I agree to the waiver.Are you paying online?* yes no Online payment choicesDrop-in $15.783 class pass $41.255 class pass $52.55Week unlimited $84.10Month unlimited $124.95*online payments include 5% processing feeQuantityTotal $0.00 How would you like to pay?* Credit Card PayPal Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name If you are paying in cash, please pay to the teacher or representative on site in USD or MXN based on todays exchange rate.Enjoy class! This iframe contains the logic required to handle Ajax powered Gravity Forms.