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Complete this liability waiver and intake questionnaire to help Yoga Bhoga and Cascadia Pilates provide the best classes and services for you.

I hereby agree to the following: I am participating in various yoga and pilates classes and workshops at Clouds Rest, LLC d/b/a “Yoga Bhoga” (“Yoga Bhoga”)  d/b/a “Cascadia Pilates” (“Cascadia Pilates”) during which I will receive information and instruction about yoga and health. I recognize yoga and pilates requires physical exertion which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

I understand it is my responsibility to consult with a physician prior to and regarding my participation in classes and workshops. I represent and warrant I am physically fit and have no medical condition which would prevent my full participation in classes or workshops.

In consideration of being permitted to participate in classes and workshops at Yoga Bhoga or Cascadia Pilates I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

In further consideration of being permitted to participate I knowingly, voluntarily and expressly waive any claim, suits, losses, damages, liabilities, fees and/or expenses (collectively, “Claims”) I have or may have a right to bring against Yoga Bhoga or Cascadia Pilates and its predecessors, successors, agents, employees, members, officers and assigns (collectively, the “Released Parties”) related to my participation in Yoga Bhoga’s yoga classes, Cascadia Pilates pilates classes, workshops and programs, including without limitation Claims for personal injury, death or property damage caused by any act, omission or negligence of the Released Parties. I, on behalf of my heirs or legal representatives forever release, waive, discharge and covenant not to sue the Released Parties from any and all Claims known or unknown that I may have against the Released Parties resulting from my participation in Yoga Bhoga’s yoga classes, Cascadia Pilates pilates classes, workshops and programs, including without limitation Claims for any property damage, personal injury or death caused by the Released Parties’ negligence or other acts.

I acknowledge and agree that I have carefully read this Liability Waiver and Release and understand the rights and claims that I am giving up. I intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. The provisions of this Liability Waiver and Release shall be effective and binding upon my heirs, successors and assigns and shall inure to the benefit of the Released Parties. The invalidity or unenforceability of any particular provision of this Liability Waiver and Release shall not affect its other provisions, and this Liability Waiver and Release shall be construed in all respects as if such invalid or unenforceable provision has been omitted. This Liability Waiver and Release constitutes the entire agreement among the parties hereto with respect to the matters set forth herein and supersedes all prior agreements.

First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
First Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Student's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Health Questions
Select all that apply
Diabetes
Heart Conditions
Herniated/Bulging Spinal Disc(s)
High Blood Pressure or Eye Pressure
Hypo/Hyperthyroid
Motor Control Condition (ie. Parkinsons, MS)
Nerve Impingement/Compressions (ie. Facet Joint Syndrome, Thoracic Outlet Syndrome, Sciatica)
Osteopenia/Osteoperosis
Pregnant or 3yrs Postpartum
Scoliosis
Spondylolisthesis/Stenosis
Vestibular Condition
Past Surgeries? Select all that apply
Spinal Surgery (ie. Discectomy or Fusion)
Thoracic Surgery (ie. Heart Surgery, ENT surgery)
Abdominal Surgery (ie. C-Section, appendectomy)
Lower Extremity Surgery (Feet, Knees, Hips)
Upper Extremity Surgery (Hands, Elbows, Shoulders)

Please provide detailed information about any surgery or health condition that may impact your pilates or yoga practice.
Select the preventative care activities you participate in on a regular basis
Restorative Activities (Meditation, Massage)
Aerobic Activities (Swimming, Running, Cycling)
Anaerobic Activities (Sprinting, Heavy Weight Lifting)
Mental Health Care and Screenings
Nutritional Practices
Routine Vaccination and Flu Shots
Cancer or Disease Screenings
Scheduling/Interest Questions
Select the services you are interested in at YBCP
Virtual Classes
Large group classes
Small group classes
Private sessions
Teacher Training and Continuing Education
I'm also interested in
Kids Programs
Prenatal/Postnatal Classes
Corporate or Private Group Programing
Select the times that work best for your schedule
Early Morning
Mid-Morning
Lunchtime
Afternoon
Evening
Weekends

What are your movement goals?

What are some other general life goals that your yoga practice or Pilates practice may support?

Is there additional information that you would like us to know?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Pronoun
Select all that apply*
She/Her
He/Him
They/Them
Prefer not to say
Have you received your COVID vaccination?*
Yes
No
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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