Registration Form Please
print the form below, complete and mail with payment to: For more information, call: (508) 885-2620 Indicate choice of Class(es) and Workshop(s) here: (Include class day & time, if applicable) ____________________________________________________________________________ ____________________________________________________________________________ Name: __________________________________________ Address: ________________________________________ City/State/Zip: ___________________________________ Email:_____________________________Phone:___________________ Known Physical Limitations :____________________________________________________ ___________________________________________________________________________ ____________________________________________________________________________ I hereby stipulate that I am physically sound to proceed with instruction in the above stated class. It is further agreed that all exercises and lessons shall be undertaken at my sole risk and that Lauren J. Toolin, d.b.a. The Metta Center, and The Metta Center staff, shall not be liable for injuries or damages to my person or property arising out of, or connected with, the use of services or facilities while taking class or private instruction. I do hereby forever release and discharge Lauren J. Toolin, d.b.a. The Metta Center, and Metta Center staff from all such causes of action. Signature:______________________________ Date: _______________ |