2-in-5 Visitor Card
Welcome to Bikram's Beginner Yoga classes and the Hot Room -- for people who are looking for optimal health and a challenging workout. You're in the right place! Enjoy the next 5 days; please book your first 2 classes according to the best schedule for you.
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Sex: Male / Female Date of Birth: _____________ If referred by a Health Practitioner: ________________________
How did you hear about us? ______________________________________________________________________

Objectives
What is your main reason for coming? (tick as many as you wish)
To supplement my training/exercise __________________ To lose weight __________________
To begin exercising __________________ To increase my lung capacity __________________
To tone my body __________________ To increase joint mobility __________________
Get strong and flexible __________________ To have time for myself __________________
To increase my concentration / focus __________________ Other ______________________________________

What conditions would it be better that we are made aware of? (medical or physical, sore neck or lower spine, reconstructed knee?)
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What medication, if any, are you taking? _____________________________________________________________
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Have you done yoga before? Yes / No If Yes, what kind: _________________________
How fit do you consider yourself to be now? 1    2    3    4    5 1 = unfit, 5 = very fit
Are you a smoker? Yes / No

In consideration of and as an inducement to you enrolling me as a student of
Bikram Yoga Victoria I represent and agree as follows:

1. I have been examined by a licensed physician within the past six months and have been found by such physician to be in good physical health and fully able to perform all Yoga exercises which I am to learn and perform during my enrolment with you.
2. I will faithfully follow all instructions given me by you and your instructors as to when, where and how to perform and not to perform Yoga exercises, it being understood that any deviation by me from such instructions shall be at my own risk.
3. I will not hold you, your partners, instructors, or employees responsible for any injuries suffered by me caused whole or in part by my failure to faithfully follow the instructions of you or your instructors or by any physical impairment of mine not fully disclosed to you in writing.
4. I understand and acknowledge that I am to receive instruction in Yoga theory and exercises only and I will not hold you, your partners, instructors, or employees to any higher standard of care than that applicable to a school of Yoga theory and exercises.
5. The tuition paid herewith and such registration fees paid hereafter are non-refundable; such refund, if any, as are made will be entirely within the discretion of Bikram Yoga Victoria

Signature: _____________________________________ Date: _________________
Please Note: All sales are non-refundable and non-transferable.