Register online

Or print this form fill it out and bring it with you.
Personal/contact information
Enter date of bith in the format YYYY-MM-DD
Medical/professional referral
If you were referred by a Health Practitioner, please include:
Objectives
What is your main reason for coming? Choose as many as you wish:
Health
What conditions would it be better that we are made aware of (medical or physical, sore neck or lower spine, reconstructed knee)?
What medication you are currently taking?
Agreement

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

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
2-in-5 Intro Special: 2 Classes in 5 Days!