Class Registration & Private Lessons Home Class Registration & Private Lessons This page is for Classes & Private Lessons. For Workshops, click HERE. Click on this link to download a printable Registration Form (Winter 2015) Class Registration and Private Lessons Today's Date* Name* First Last Email* City, StateHow did you hear about us?Primary Phone*Primarily for cancellations or questions.In the event of an emergency, who should we contact? First Last What number should we call (during your class time)?Health ConditionsBirthdate* MM DD YYYY How long have you been practicing yoga?I'm a beginner0-1 year1-4 yearsMore than 4 yearsI'm returning after an absencePresent State of Health*PoorFairGoodVery GoodExcellentPlease Explain Detail any conditions which your instructor should be aware of that might affect your participation in yogaPlease check all Health Conditions which apply to you Sinus Condition Heart Trouble Intestinal Complications High or Low Blood Pressure Back Problems Knee Problems Arthritis Epilepsy Asthma Ulcers Allergies Recent Surgery More Information and/or Medications Waiver Agreement (read and indicate "I Agree")*I AgreeI understand that all activity has its attended risks. Furthermore, I understand that I am under no obligation during a yoga class or workshop to attempt any poses (asanas) that conflict with my perceived limitations or injuries. I agree to check with a qualified physician prior to beginning any new exercise program. I also agree to notify my instructor of any conditions, limitations or injuries prior to the commencement of each class or workshop. The Rivertown Center for Yoga & Health is a member of a network of yoga studios affiliated with the Kripalu Center for Yoga & Health, Stockbridge, Massachusetts. This yoga studio like all Kripalu affiliated yoga studios, is independently owned and operated. Kripalu Center for Yoga & Health is neither responsible nor legally or financially liable for the activities conducted at this yoga studio. In signing below I hereby release The Rivertown Center for Yoga & Health and any of its owners, staff, affiliates or instructors from any liability in connection with any injuries sustained as a result of activity during a yoga class or workshop. Photography Waiver*I AgreeI Do Not AgreeFrom time to time, we will be taking photographs and video for promotional purposes. Please indicate if you agree to have your likeness reproduced on our website or for printed matter (brochures, newspaper, etc.).Spring 2015 Classes (4/6/15 - 6/28/15)Select Your options from the drop-down menus. YOU HAVE TO SELECT SOMETHING FROM EACH MENU, SO PLEASE SELECT "NONE" OR "NOT AT THIS TIME" IF IT APPLIES.12 Session Yoga Class ($204)*NONEMonday 9:30 am Gentle with DonnaTuesday 7:30 am Gentle with PatriciaTuesday 9:15 am Moderate with ChrisTuesday 4:00 pm All Levels with DeborahThursday 9:30am Mixed Level with PatriciaThursday 7:00 pm Yoga/Meditation with BethFriday 9:30 Gentle with ChrisSaturday 9:30 Yoga/Meditation for Moderates with BethSaturday 11:15 Beginner's Mind Yoga with HasitaSunday 4:00 pm All Levels w/ BethSeniors and Students See BelowSeniors (65+) and full-time students - 12 Session Class ($184)*NONEMonday 9:30 am Gentle with DonnaTuesday 7:30 am Gentle with PatriciaTuesday 9:15 Moderate with ChrisTuesday 4:00 pm All Levels with DeborahThursday 9:30am Mixed Level with PatriciaThursday 7:00 pm Yoga/Meditation with BethFriday 9:30 am Gentle with ChrisSaturday 9:30 am Yoga/Meditation - Moderate with BethSaturday 11:15 am Beginner's Mind Yoga with HasitaSunday 4:00 pm All Levels w/ BethOther Packages*NONEFive Class Pack ($100)Unlimited Monthly Yoga ($125)One Private Yoga or Reiki Lesson at Rivertown ($100One Private Yoga or )Reiki Lesson at Your Home/Office ($125)4-Pack Private Yoga or Reiki Lessons at Rivertown ($300)4-Pack Private Yoga or Reiki Lessons at Your Home/Office ($400)Addt'l 15 Class Package for a Family Member ($204)5 for $100 must be used by the end of the season. Private packages must be used within 12 months of date of purchase. Scholarship Fund Donation*Supporter ($25)Partner (50)Angel ($100)Not at this timeHelp someone else afford yoga classes! Payment Agreement*I AgreeBy indicating "I Agree", you are committing to pay in full the total amount to The Rivertown Center for Yoga & Health. If you have to cancel your attendance FOR ANY REASON and would like a refund or credit, you must do so by contacting the Director within 48 hours of the first class.Please indicate how you would like to pay*PayPalPay later with a checkPlease send checks to: Beth Bierko, 999 Cliff Avenue, Yorktown Heights, NY 10598 made payable to "Rivertown Center". Your registration is not complete until your payment is received. If you are registering on the day of the event or class, please print this form and bring it with you. Thanks!Your Total $0.00 PLEASE REVIEW YOUR PURCHASEIf the total above does not agree with what you planned to purchase, please review the items selected before hitting "SUBMIT". Remember, you need to make a choice from every menu - even if it's NONE or NOT AT THIS TIME.