LONG BEACH YOGA CENTRE
Reservation and Release Form
Zen Mountain Center
Print this form, fill out completely and mail as instructed.
RESERVATION FORM

Name:______________________
Address:_____________________
city:_________________________
Phone:_______________________
e-mail:_______________________

Please reserve__________spaces.
Amount______________enclosed

SPACE IS LIMITED

Send complete form and $ 75.00 deposit to:
Long Beach Yoga Centre
317 Termino Ave
Long Beach, CA 90814

For information call:
Irene (562) 433-7285
e-mail: yogini777@aol.com

IMPORTANT TO REMEMBER
PLEASE PLAN TO ARRIVE BEFORE
DARKNESS PREVAILS!!!!

Release of all claims and liability

I hereby waive, release and discharge any and all claims for damages, for personal injury or property damage which I may have or which may hereinafter inure to me, my heirs, or my beneficiaries as a result of my participation in said Yoga activity. This release is intended to discharge in advance Irene Holsters, Yoga Instructor, and Zen Mountain Center, P.O. Box 43, Mountain Center, CA. 92561, on which Yoga activities is to be conducted from and against any and all liability arising out of or connected in any way with my participation in said Yoga activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I have fully read this form and fully understand the contents thereof and hereby freely apply my signature below as my agreement to this release of liability form.

_____________________________ ________________________

Patricipant’s signature and Date: