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Yogacara

inspiring you to live the life you want
Membership Form

Welcome to the Yogacara Community!  We look forward to helping you reach your wellness goals and request you to please fill out the following information to help us serve you better.  Your opinion is very important to us, so please keep in regular touch with us and do let us know how we are doing.


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Membership Type*  
Name*  
Date of Birth*      
Email Id*  
Tel No(M)*  
Address*  
Anniversary  
Please inform us of your medical problems or any physical issues you may have:
Medical Checklist:

History of Heart Disease   Yes   No
High Blood Pressure   Yes   No
Low Blood Pressure   Yes   No
Diabetes   Yes   No
Back, Knee or Joint Problems   Yes   No
Vertigo   Yes   No
Migraines   Yes   No
Other (Please Specify)
 
Do currently exercise, if yes, what do you do?
How do you rate your level of fitness?
Please tell us about your wellness goals; these can be general fitness goals or the need to improve upon a particular mental, physical or emotional condition. This helps us provide you proper guidance in your yoga practice, enabling us to give you individual attention to help meet your needs.
Have you ever done Yoga before, where, and for how long?
Which of our services are you interested in?
Yoga Massages Ayurveda WorkshopsRetreats
 
Emergency Contact:

Name:
Relationship:
Tel (m):
Would you like to refer any friends or family to Yogacara, You receive Rs 400 in Wellness Bucks for every person who signs up. Your wellness bucks can be used against any services at Yogacara, including a membership renewal.
How did you hear about Yogacara?
May we contact you for feedback on our services?  Yes  No 
 
Terms of Agreement
. Membership fees are non-refundable and non-transferable, and unused classes cannot be carried over to a new membership period. Memberships expire as per the package selected above from the date of purchase.
. All treatments packages are valid for a period of six months, and are non transferable and non refundable.
. Membership Freeze: Members are welcome to freeze their memberships via an email request: 3 Month (1 week), 6 Months (2 weeks), Annual (1 month).
. We will be closed for most major public holidays. For any additional time off by our staff, substitutes will be provided where possible. We also operate on a lighter schedule during certain slower months of the year; if a class falls below 3 students, we reserve the right to merge classes, and students will be notified accordingly.
. You are requested to please advise us of any health conditions you may have, be it mental, emotional or physical so we may help you achieve your wellness goals in a safe and proper manner.
. It is advisable not to eat 2 hours prior to a yoga session. Only fruit eaten on an empty stomach is permitted up to 45 minutes before.
 
Code of Ethics
Our members acknowledge that Yogacara Healing Arts is committed to the highest of professional standards and a strong code of ethics. Our trainers and therapists are guided by the following guidelines:
1. To demonstrate commitment to provide the highest quality of services to those who seek our professional service.
2. Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues
3. Demonstrate professional excellence through regular self-assessment of strengths, limitations, and effectiveness by continued education and training.
4. Acknowledge the confidential nature of the professional relationship with clients, and respect each client's right to privacy within the constraints of the law.
5. Project a professional image and uphold the highest standards of professionalism.
6. Accept responsibility to do no harm to the physical, mental and emotional wellbeing of self, clients, and associates.
7. Refrain from engaging in any sexual conduct or sexual activities involving our clients in the course of a massage therapy and other sessions.
7. Refrain from engaging in any sexual conduct or sexual activities involving our clients in the course of a massage therapy and other sessions.
8. Be truthful in advertising and marketing, and refrain from misrepresenting his or her services, charges for services, credentials, training, experience, ability or results.
 
With the online submission of this form, I state that I have completed this form truthfully and to the best of my knowledge and ability. I voluntarily agree to the terms stated above, and to receive treatments and take classes at Yogacara. I have been given ample opportunity to ask any questions, and also to become aware of any risks associated with the treatment(s), and classes that I have elected to take.
For any information pertinent to my health and wellness that I have withheld from Yogacara, I waive the right to claim any damages and agree to release and hold harmless the establishment of Yogacara and all it's owners, management, employees, their agents, heirs, beneficiaries, executors, and legal representatives, from any and all liabilities, suits, claims, losses and damages of any kind.
 
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Email:
 
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