Avita Yoga Essentials Sign Up Avita Yoga Essentials Sign Up Name* First Last Email* Birthdate* Date Format: MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country What is your goal in participating in the Avita Yoga teacher training?If you are active, what kind of activity do you do? How often?Please indicate any serious illnesses/conditions, past or present, and to what extent they affect your quality of life.Please indicate any aches & pains, or areas of chronic stiffness, and to what extent they affect your quality of life.Please share any other information that might help us better understand your health, general interests, and goals for your practice and training.Did anyone refer you to the Avita Yoga Teacher Training Program?Please share their name if so!Program Participation Agreement I understand that if I am paid in full and fulfill all the requirements of Yoga Loft Avita Yoga Teacher Training, including in-class hours, homework, I will receive a certificate of completion. I also understand that paying for the teacher training and completing the hours alone does not mean I will pass the teacher training. Students must pass all of the components of the program to the satisfaction of the school in order to graduate. I understand that Yoga Loft reserves the right to ask me to leave the program, without refunded tuition, if my behavior is unethical, disruptive, inappropriate, or negatively impacts the learning of other participants. Students are required to follow the widely accepted Yoga Alliance Code of Conduct which can be found at www.yogaalliance.org. I understand that Yoga Loft reserves the right at anytime to ask me to leave the training if it appears that my health or physical practice are not at the level to fully participate in the training. Under such circumstances, I understand I will be given a prorated refund, based on the amount of time I have attended the training. Under such circumstances, I understand I will be given the opportunity to retake the program at a discounted rate. If the teacher training is canceled for any reason, at any time and I am not able to complete the training, I will receive a prorated refund for the portion of the training that I have not completed. I understand that practice and teaching of yoga includes physical, spiritual and emotional components and that these components will be included in this program either directly through discussion or indirectly as the subject may arise. I understand that if I cancel 14 days prior to the start of the training, my deposit may be transferred toward a future Teacher Training and I will be refunded my remaining balance. If I cancel within 14 days before the start of the training, I will forfeit my $500 deposit but my remaining balance will be refunded. Once the program begins, tuition is non-refundable and non-transferable. I understand that all Yoga Loft and Avita Yoga Teacher Training materials are under copyright protection and cannot be reproduced by me without the permission of Yoga Loft owners. Failure to comply may result in legal action.I agree with the above Program Participation Agreement* Agree Release and Waiver of Liability In consideration for my participation in Yoga Loft's Teacher Training and Immersion Program, I, individually, and behalf of my relatives, legal representatives, and assigns, agree not to sue and hereby agree to defend, indemnify, release and hold harmless to the facility where I am taking my training and Yoga Loft and each of their respective shareholders, owners, officers, directors, members, employees, contractors and agents, and the owner of the facility where the Teacher Training Program occurs (collectively, the "Releasees") from all actions, claims, demands, suits, losses, liabilities, charges, expenses (including, without limitation, attorneys' fees), and costs of any nature whatsoever which may arise out of, relate to, or result from, any injury, economic loss or any damage to me or my guest or relatives resulting from participation in physical exercise and yoga instructional classes and teacher training on Yoga Loft's behalf or anyone using the Facility or Yoga Loft's equipment, facilities or services, except such as may arise of the gross negligence or willful misconduct of the Releasees. This release and waiver of liability ("this Release") is intended to be a complete release of any responsibility for personal injuries and/or property loss/damage sustained by me while at the Yoga Loft, whether using exercise equipment, participating in active or passive exercise, or not. I understand that this Release is intended to be as broad and inclusive as is permitted by the laws of the jurisdiction applicable to the facility where I am taking my training and that if any portion of this Release is held invalid, I agree that the balance of this Release should continue in full force and effect.I agree with the above Program Participation Agreement* Agree with the Release and Waiver of Liability Assumption of risk, health warranty, release and waiver of liability Yoga is an individual experience and I understand that I should progress at my own pace while participating in the physical active portions of the Yoga Loft Teacher Training Program. If at any point I feel overexertion or fatigue, I will respect my own body's limitations and I will rest before continuing Yoga or any other exercise. I acknowledge that participating in the Yoga Loft's Teacher Training program naturally involves the risk of injury to me. I further acknowledge that specific risks include injuries resulting from overexertion, physical adjustment, improper or negligent use of equipment, failure to follow trainer instructions, or injuries resulting from participation in an inappropriate level of physical exercise. As such, I understand and voluntarily accept these risks. I represent that I am in good health, at least 18 years of age, have the necessary current medical approval to engage in physical exercise and yoga instructional classes and teacher training and have no disability, impairment, injury, disease or ailment which would cause risk of injury or adverse health consequences as a result of engaging in physical exercise and yoga instructional classes and teacher training. I acknowledge that to the facility where I am taking my training and Yoga Loft are relying on this representation and I understand that Yoga Loft will not investigate or certify my health or my fitness to participate in the physical exercise and yoga instructional classes and teacher training.I agree with the above Assumption of risk, health warranty, release and waiver of liability* Agree with the Assumption of risk, health warranty, release and waiver of liability Date* Date Format: MM slash DD slash YYYY Signature*Please use your finger, mouse to create your signature.What is THREE + 4?*Our SPAM filterPlease enter a number from 7 to 7.After you click SUBMIT, you will be redirected to a page where you can pay your deposit.