Name *

First Name

Last Name

Would you like to receive email updates (class cancellations, new class times, new offerings, etc.?)

Yes please

No thank you

Rate Current Level of Low Back Pain, if any (0-10 scale)

0 (no pain)

1

2

3

4

5

6

7

8

9

10 (severe pain)

What is your permission level for your photo to be used in class promotions?

Only without my face being identifiable

Yes, and including my face is okay

None of me please, even without my face

Safety Check (all are required) *

I understand that Amy Sundari Finlay is not a doctor, and that if I'm experiencing back pain I should consult with my doctor to ensure this material is relevant to my particular back.

I understand that it is my responsibility to stay within my own pain-free movement range as much as possible, regardless of cues.

I understand that the use of chairs as props poses some risk due to potential slipping or tipping of chairs. I understand that the rubber chair coasters offered to reduce slipping and mat wear do not guarantee no chair movement. I agree to proceed with caution, evaluating the limits of the chair ahead of practice and as needed ahead of following cues. I take full responsibility for my safe use of this prop.