New Student Registration

Please complete this form to register for classes at the Yoga Institute of Broward.

Personal Information
Emergency Contact
Health History
List all present physical and mental problems and brief synopsis of past problems. (Indicate diagnosis by health care professionals and your symptoms. We need to know what you are experiencing.)
Past Yoga Experience
Agreement of Release and Waiver of Liability
Please read the following AGREEMENT OF RELEASE and WAIVER OF LIABILITY carefully before submitting this form