POWER PAINTING REGISTRATION FORM Name * First Name Last Name Email * If you can choose one power word, what will it be? * What animal or symbol represents Power and strength to you? * What is your favorite color? * The following conditions require specific modifications to your yoga practice. Please tick if any of the following apply to you. If you tick any, please provide further details below. Abdominal disorders Arthritis (osteo/ rheumatoid) Anxiety Back pain/ problems Cancer Depression Heart conditions / disorders High blood pressure Hip problems Low blood pressure/ fainting Knee problems Nerve damage / trauma Osteoporosis Pain, stiffness, swelling Pregnancy / recent pregnancies Broken bones Surgery (in the last two years) Shoulder / neck problems Have you practiced yoga before? If so, please explain your experience. Is there a specific area in your body that is currently bringing you sensation or pain that you would like to focus on for yoga? What are your goals and expectations for Power Painting? * Is there anything else you would like me to know? I take full responsibility for my health and will not attend if I am sick or feeling discomfort. I am fully aware of this risk and hereby release Noble Alkhemy (Dee Davis) from any and all liability, negligence or other claims arising from or in any way connected with my participation in Power Painting and yoga classes. Signed: Date: Thank you! We look forward to having you! Please remember to wear clothes you do not mind getting paint on.
