Yoga Waiver and Release Form

Name:

Birth Date: *

Address:

Phone:

Email:

Emergency Contact Name:

Emergency Contact Phone Number:

Have you ever done yoga before?

How physically active are you?

Please list any medical conditions that may impact your health while participating in yoga (such as asthma or a heart condition):

I understand that yoga includes physical movements as well as a chance for relaxation, stress education, and relief of muscle tension. As is the case with any physical activity, there is risk of injury that cannot be completely eliminated. If I experience any pain or discomfort, I agree to discontinue the activity and ask for support from my instructor at YOUR STUDIO NAME. I assume all responsibility for any and all damages which may occur during participation.

Yoga is not a substitute for medical attention, examination, diagnosis, or treatment. Yoga is not recommended and is not safe for people with specific medical conditions. Getting clearance from a physician is recommended before starting any new exercise regime. I affirm that I have either gotten permission from a physician or have chosen to not seek out clearance for participating in a yoga class. In addition, I will make sure the instructor at YOUR STUDIO NAME knows of any medical conditions or physical limitations before I begin the class. I also affirm that I am responsible for my decision to practice yoga and that participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against YOUR STUDIO NAME and its instructors.

I have read and fully understand agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of liabililty to the greatest extent allowed by law in the State of: YOUR STATE HERE.

Signature:

Date: