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Release of Liability for all Classes and Workshops at Ashtanga Yoga Bellingham & Bellingham Yoga

 


Agreement of Release and Waiver of Liability

I hereby agree to the following:

1. That I am voluntarily participating in yoga classes or worships offered by Ashtanga Yoga Bellingham/Bellingham Yoga during which I will receive information and instruction about yoga. I recognize that yoga requires physical exertion, which may be strenuous and may cause injury, and I am fully aware of the risks and hazards involved.

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

3. In consideration of being permitted to participate in the yoga classes and/or workshops, 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 offered by Ashtanga Yoga Bellingham/Bellingham Yoga.

4. I fully understand that if I injure myself as a result of my participation in Ashtanga Yoga Bellingham/Bellingham Yoga exercise program that I hereby release Ashtanga Yoga Bellingham/Bellingham Yoga, Luke Baugh, or any of its employees, owners, and individual instructors or affiliates, from liability now or in the future, including but not limited to heart attacks, muscle strains, pulls, tears, broken bones, shin splints, heart prostration, knee, lower back or foot injuries and any other illness, soreness, or injury however being permitted to participate in the yoga classes and workshops, I knowingly, voluntarily and expressly waive any claim I may have against Ashtanga Bellingham, for any injury or damages that I may sustain as a result of participating in the program.

5. I agree to assume full responsibility for any injury or impairment that may occur as a result of earthquake, fire, or by any other Act of God.

6. I, my heirs or legal representative forever release, waive, discharge and covenant not to sue Ashtanga Yoga Bellingham/Bellingham Yoga or any of its teachers, for any injury or death caused by their negligence or other acts.

7. I know that yoga requires alignment of the body and that yoga teachers often adjust students to help them get the poses more accurately. By signing below, I consent to such touch and adjustment. If I do not wish to be touched I will clarify that fact in a signed writing and hand it to every teacher whose classes I attend prior to the commencement of that class.

8. I realize that just as students choose their teachers, teachers also choose their students, and that some teachers may choose not to accept me as a student, and I agree to abide by the teachers choice in the matter.

9. I realize that all tuition fees, once paid, are not refundable and that classes are offered on a first-come, first-served basis.

10. I recognize that if I have any physical impairments, if I smoke cigarettes, if I am pregnant, have any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury) that may affect my ability to practice yoga, I will inform the studio in writing before I undertake classes and I will inform the instructor(s) verbally during class.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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 Information
Do you have or have you had any physical difficulty (such as heart disease, high blood pressure, overweight, pain or pressure in the chest, back or knee problems, surgery, injury, pregnancy) that may affect your ability to practice yoga?*
No
Yes
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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