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Inquiry & New Student Registration Form: (fill out both when registering)

Name

First Name

Last Name

Phone

(###)

###

####

What services are you interested in?

Monthly Tuition

Drop-in

Private (single session)

Private (package)

Preferred Start Date

YYYY

Do you have an established Ashtanga Yoga practice?

Are you a resident of Maui or traveler? Please include the dates you intend to attend practice below:

Have you practiced Ashtanga Yoga? And what other styles of yoga have you practiced? If so, please share details (length of time, frequency of practice, what series if Ashtanga, and where).

Any questions?

New Student Registration Form: (continue filling out below to register)

Registration, Disclaimer, Waiver, Release of Liability Disclaimer:

Disclaimer, Waiver, Release of Liability Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC and its staff teachers reserves the right to amend this policy at its sole discretion. RELEASE OF LIABILITY I understand that the risk that I may become exposed to or infected by BY THE FLU, COMMUNICABLE ILLNESS, COVID-19 and it is my sole responsibility and Caio Amaral LLC , Shala Santosha Yoga & Wellness LLC waives all liability, as for mentioned best practices will be followed. I release all liability from Caio Amaral Yoga LLC , Shala Santosha Yoga & Wellness LLC from the actions, omissions, or negligence of myself and others, including, but not limited to, Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC, employees, volunteers, and participants. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the studio or participation in Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC events and/or services. I hereby release liability and hold harmless Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC, its employees, agents, and representatives from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereof. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC, its employees, agents, and representatives, whether a FLU, COMMUNICABLE ILLNESS, COVID-19 infection occurs before, during, or after participation in any Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC activity or admittance into the facility. I understand my responsibility in staying home when ill, maintaining proper hygiene, and following the proper procedures by your health care provider when participating or attending Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC classes and services. * I, hereby agree to the following:  * I) I am aware that participation in yoga class or related workshops requires physical exertion, which may result in accident or injury. I am aware of the risks and hazards involved and I assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in yoga or related activities. I am also aware of the risks and hazards of being exposed to either COVID, Flu that may unknown at the time and assume full responsibility for any risks, injuries, medical expenses, damages known or unknown which I might incur as a result of participating in yoga or related activities. I have been informed that the shala does not discriminate and accepts all students vaccinated or not to attend yoga practice. Caio Amaral is not vaccinated and this is a public awareness and announcement for your own decision to continue to study at the shala. * II) I represent that I am in good health and suffer from no physical impairment or medical condition that would limit use of Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC and its staff teachers Maui Shala facilities. I acknowledge that Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC and its staff teachers and any instructors have not and will not render any medical services including medical diagnosis of my physical condition. I understand that it is my responsibility to consult. * III) I specifically agree that Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC and its staff teachers shall not be liable for any claim, demand, cause of action of any kind whatsoever for, or on account of death, personal injury, medical expenses, property damage or loss of any kind resulting from or related to participation in yoga practice or any related activity. I agree without limitation to hold Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC and its staff teachers harmless from the same. * IV) I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC and its staff teachers for any injury or death caused by negligence or any other acts. I have read the above release and waiver of liability and fully understand its contents. I knowingly and voluntarily agree to the terms and conditions stated above. YOGA LIABILITY WAIVER & INTAKE FOR CHILDREN, TEENS and ADULTS I hereby agree to the following: I and/or my child has permission to attend a yoga class from Caio Amaral LLC, Shala Santosha Yoga & Wellness LLC. I and/or my child are participating in classes or services during which we will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my and/or my child’s participation in any physical fitness program, including yoga. I represent and warrant that I and/or my child have no medical condition that would prevent us from participation in physical fitness activities. In consideration of being permitted to participate in the yoga classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I and/or my child might incur as a result of participating in the program. In further consideration of being permitted to participate in the yoga classes, I knowingly, voluntarily, and expressly waive any claim I and/or my child may have against the instructor, the owner, or the leaseholder of the building for injuries or damages that I and/or my child may sustain as a result of participating in classes or workshops conducted by Caio Amaral Yoga, Shala Santosha Yoga & Wellness LLC If I and/or my child participates in other classes or events at Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC, I will also assume full responsibility for any injuries that may result from our participation, with the same considerations that this waiver stipulates for yoga. For classes taken with an instructor that is also a healthcare professional, my signature below further acknowledges that in this setting the instructor is acting solely as a yoga instructor. PHOTO RELEASE: I give my permission for Caio Amaral Yoga LLC, Shala Santosha Yoga & Wellness LLC to use my or my child’s image (photo or video) for website, media, newsletter and teaching seminars. I have read the above release and waiver of liability and fully understand its content. I voluntarily agree to the terms and conditions stated above

I hereby have read and understand

I hereby agree to release all liability

How many days are you available to commit to your personal practice at the shala?

The tuition is set as a monthly commitment.

Do you have any injuries, illness, conditions?

Do you have Allergies to oils, incense, fragrance?

If yes, please define what reaction takes place. If no, write NONE

Please list medications prescribed including if you are using a medicinal card for cannabis use as medicine for your condition

The shala has a policy to refrain from the use of substances such as Cannabis, TCH, CBD, Mushrooms, etc most especially prior and during practice and after practice. Please read student etiquette prior to registering for class as private lesson may be more suited for your practice until cessation or sobriety is in progress.

Are you currently in Rehab, Sobriety for drug, alcohol, addiction, Therapy with Psychologists or treating doctors for health, mental, physical, emotional conditions?

Please describe or write NONE

Ashtanga Shala Santosha Yoga & Wellness

810 Haʻiku Rd, Unit 404

Haiku, HI 96708

Mysore Hours

Monday 4pm-6pm

Tuesday 4pm-6pm

Thursday 4pm–6pm

Saturday 8am-9:30am