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COVID-19 Information

Covid-19 Health Declaration

This Health information can be completed now, and will be revisited when you arrive at the studio. Please review ALL questions & Submit form upon checkout.

First Name

Last Name

Email

My body temperature is lower than 100.4°F/ 38°C

I am not experiencing the symptoms: fever, chills, cough, sore throat, shortness of breath, muscle pain, loss of taste or smell.

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Kamalika-K Participant Liability Waiver

Please Complete the form to Confirm your acceptance of Liability Waiver.

Required Only the first time you are booking a class, for yourself of for your child. Effective from first date signed.

Student's First Name

Email Address

Student's Last Name

Date of Birth

Do you have any illness/health concerns that we should be aware of?

No

Yes

Check if you are experiencing a health concern that will still allow you to participate in yoga classes, and will inform the instructor prior to class start.

Yes, I will inform the teacher prior to beginning of my class.

Initials

Today's Date

Liability Waiver Confirmed

I declare that the info I’ve provided is accurate & complete.

Karen Santorello, E-RYT500, RCYT

IASH | TSRY | YIN | DYW | Reiki | CPR/AED

45 Upper Main St, #101

Essex Jct, VT 05452

802.871.5085

The Barns at Lang Farm

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IG: @kamalika_k

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