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PLEASE FILL OUT THE FOLLOWING
Form must be filled out prior to entering class.
*
Indicates required field
Name
*
First
Last
DATE
month
*
January
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March
April
May
June
July
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October
November
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Day
*
1
2
3
4
5
6
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8
9
10
11
12
13
14
15
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17
18
19
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21
22
23
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27
28
29
30
31
Year
*
2020
2021
2022
2023
2024
2025
Class Time
*
Select One
*
AM
PM
HAVE YOU EXPERIENCED ANY OF THE FOLLOWING COVID-19 SYMPTOMS IN THE PAST 14 DAYS?
*
Fever or chills
Cough
Shortness of breath
Difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
None of the above
Have you tested positive taking a COVID-19 test in the past 14 days?
*
Yes
No
Have you been in close contact with a confirmed or suspected COVID-19 case in the past 14 days?
*
Yes
No
Submit
info
studio info
Class Descriptions
Instructors
Contact
Schedule
Events
Workshops
Parties
Paddle Board Yoga
Space Rental
Yoga Privates
Services
trainings
200 HR YTT
500 HR YTT
Wheel YTT
Reiki Training
Store
