registration and health form

Please complete this form each time you register for a class or purchase a drop-in / flex pass.

Please note – completing our Registration and Health Form DOES NOT register you for class! Receipt of payment confirms registration. See here for payment options.

Name*
First Last
Phone
Email*
Class*
REMEMBER: Age 65+ receive 5% off on full session classes only.

For most people physical activities should not pose any problem or health risks. However if you have any physical or medical conditions that may be aggravated by physical participation, you should consult your doctor or health care advisor as to whether you should participate in this program. You must also inform your instructor.
1) Do you have any health concerns or preexisting medical conditions?
- Yes
- No
If yes, please specify:
2) List any prescription or non prescription medication you are taking and for what.
Please list any history of surgeries, major illnesses, chronic conditions, accidents, injuries or mental health concerns. Please list any dates that apply.
3) Are you pregnant?
- Yes
- No
If yes, what is you due date and please provide a doctors note.
Date Format: MM slash DD slash YYYY
4) What is your primary reason for taking this class?
How will you be paying?

E-transfer: Email to [email protected]. In the memo, enter the class name(s), day(s) and time(s).

Cheque: Mail to Every Day Sacred PO Box 37235 Regina South, Regina SK S4S 7K4

Important Tips
• Students MUST bring their own mat and a thick blanket to class.
• It is recommended to dress in layers.
• Park in the parking lot to the east side of the building.
• Enter and exit through the South doors.
• Place all outerwear and footwear in the space provided in the hallway.
• Bring keys and valuables into the class space with you.
• Every Day Sacred is not responsible for lost or stolen articles.
I Understand that I am solely responsible for my health, safety, and well being.*
- I release Every Day Sacred from any and all responsibility for damages incurred by injuries received while participating in this program.
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Please complete this form each time you register for a class or purchase a drop-in / flex pass.

Please note – completing our Registration and Health Form DOES NOT register you for class! Receipt of payment confirms registration. See here for payment options.

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