First Name: ________________ M: __ Last Name: __________________

Address: __________________________________________________

City: ______________________________ State: _____ Zip: __________

Home Phone: (____) ____________ (Work/Cell): (____) ______________

E-mail: ____________________________________________________

Learned About Flo Yoga & Pilates from:

__________________________________________________________

I agree to limit my participation in yoga/pilates classes to the level of activity
that is comfortable to my physical situation at the time.

I understand that I am waiving Flo Yoga & Pilates and instructors from any
and all liabilities by participation in yoga/pilates classes.

Signature: ________________________________
(Parent/Guardian if under 18)

Sign: ______________________________

Date: ___________

Please print, fill out and bring with you to class or

Mail to:

Flo Yoga & Pilates
26944 Camino de Estrella #1
Capistrano Beach, CA 92624