New Student Intake Form

Entry of information is optional (ie; you don’t need to put down your home phone if you don’t want(we only use phone numbers when you forget something at the studio)). Your information will never be sold or distributed to any third party.

First Name:

Last Name:

Email:

Are you interested in receiving our monthly email newsletter (you can unsubscribe at any time)?

Yes

Home Phone:

Cell Phone:

Zipcode:

How did you hear about us?

What is general experience level with respect to practicing yoga? How long have you been practicing and what styles/class types?

Do you have any injuries or medical conditions we should be aware of? (ie; pregnant, recent ACL replacement, bulging disc, etc)

We will occasionally give gentle physical adjustments to help with alignment within yoga postures. If you are not comfortable being adjusted please note here (you are always free to change your mind later and let us know).

Is there anything else you would like us to know?

Do you have a Groupon or Living Social voucher? Enter the Groupon number (found right below the barcode in the middle of the page) or Voucher Number here. ***SAVE PAPER*** If you enter a valid number here, there is no need to printout the voucher and bring it in.

We dislike spam, so you can be rest assured that your email address will not be sold or distributed, and will not be subscribed to newsletters, unless you marked yes up above. The main reason we ask for your email is so that we have a method to follow up with you after you visit, and not for extensive marketing purposes. If you are uncomfortable with entering your email, either call us (608 301 5288) or just come in, mention our site and enjoy a complementary first class.