JEANINE GORANSON

Jan Goranson Yoga & Wellness

 

REGISTRANT DETAILS:

 

Name: _______________________________________________________

 

Address: _______________________________________________________

 

City: __________________________ Postal Code: ____________

 

Email: _________________________Telephone: ______________

 

 

Keep me updated on future events?    Yes, No  

 

 

EMERGENCY CONTACT AND TELEPHONE NUMBER:

_______________________________________________________

 

Have you practiced yoga before? Yes __________ No__________

 

If YES, for how long? _________ Which style of yoga? ________

 

What are your reasons for practicing yoga?

 

___ Stress reduction                       ___ Weight management

___ Mental clarity                            ___ Flexibility

___ Spiritual growth                         ___ Strength

___ Overall wellbeing       

___ Confidence

___ Managing a particular illness

 

Specify: _______________________________________________________

 

Other reasons

Specify: _______________________________________________________

Are you currently experiencing any of the following conditions?

 

___ Asthma                                                  ___ Dizzy spells / Fainting

___ Low blood pressure                              ___ Epilepsy / Seizures

___ High blood pressure                             ___ Diabetes

___ Heart / Circulatory Problems             ___ Pregnancy

___ Muscular injury

___ Neck / Back / Spine injury

___ Joint injury (ankle, knee, hip, elbow, shoulder)

___ Recent surgery

 

Specify: _______________________________________________________

 

Other medical condition, injury, or disability

Specify: _______________________________________________________

 

If you are currently taking medication or have any serious allergies that should be made known to medical personnel in case of an emergency, please indicate them here:

 

Waiver

Asana (yoga posture) means a posture easily held. If you feel discomfort or strain at any time during the class, gently release the posture. You may rest at any time during the class. It is important in yoga that you listen to your body and respect its limits on any given day.

 

I, the undersigned, understand that Yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before the yoga class. I will not perform any postures to the extent of strain or pain.

 

I accept that neither the instructor(s), nor the hosting facility, The Opera House 400 Spring Creek Dr., Canmore, AB T1W 0C7 | May 1 & 2, 2026, is liable for any injury, or damages, to person or property, resulting from the taking of the class(es) (indoor and outside ie, hike). Those under 18 years of age must have this form signed by a parent or guardian.

 

 

__________________________

Date

 

__________________________       __________________________

Name (Print)                                                      Signature

 

 

__________________________

Date

 

__________________________             ___________________________

Parent/Guardian (Print)                    Signature

 

 

 

 

Photo Permission

 

We’re thrilled you’ll be joining us for the yoga retreat! Throughout the event, we’d love to capture some photos and videos to reflect the positive energy and share the spirit of our community. These may appear on our website, social media, or in other promotional materials, but will never be sold or used for any purpose outside of celebrating and sharing our retreat experience.

 

If you’re okay with this, please sign below:

 

I, __________________________ (your name), permit Finding Balance Yoga Retreat to take photos and videos of me during the yoga retreat on May 1 & 2, 2026 at The Opera House / Canmore, AB.

 

I understand these photos/videos might be used to promote the retreat online. I know I can say no or change my mind by letting the organizers know.

 

Signature: ______________________

Date: __________________________

 

Thanks so much! If you have any questions, please ask us at jangoranson001@gmail.com or call 403.200.0981.