Let’s work togetherOr have a question? Fill out the info below and I will be in touch shortly. I can't wait to hear from you! Student Waiver Form Name * First Name Last Name Phone * (###) ### #### Email * Preferred Method of Contact * Text Message Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country What services are you interested in? * 1 x 1 Private Yoga Custom Group Yoga Corporate Yoga Online Yoga Preferred Date MM DD YYYY Have you ever practiced yoga before? If so, how often do you practice? Daily? Weekly? Monthly? * What other physical exercise do you do (how many times per week / for how long)? * Do you have props? Blocks? Strap? * What are your reasons/goals private yoga sessions? Ie. Mobility? Flexibility? Balance? Body awareness? Muscle strength? Reduce stress/Peace of Mind? * Please describe any health issues or concerns, such as injuries, illnesses, areas of tightness/discomfort, etc. * Is there anything else you’d like to share? How did you hear about me? * Thank you for your inquiry! I’ll get back with you soon.-Jessica