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Body Love Yoga
Waiver & Release Form

Health & Fitness Liability Waiver / Informed Consent Form

I have voluntarily enrolled in the health and fitness program known as Body Love Yoga. I recognize that I am fully responsible for my self care and body self awareness.

I recognize that the program may involve strenuous physical activity including, but not limited to, stretching, muscle strength and endurance training, cardiovascular conditioning and training, and other various  fitness activities and stretches. I hereby affirm that I am in good physical condition and do not have any known disability or condition which would prevent or limit my participation in this exercise program.

Should I have a disability or condition that would prevent or limit my participation, I affirm that I have discussed with my physician before beginning this exercise program. I hereby affirm that I have worked with my healthcare professional to design an appropriate exercise prescription.

If I experience any pain or difficulty with these exercises, I will stop and consult my healthcare provider. If I experience any symptoms of weakness, unsteadiness, light-headedness or dizziness, chest pain or pressure, nausea, or shortness of breath, I will stop and consult my healthcare professional.

I understand that mild soreness after exercise may be experienced after beginning a new exercise. If the soreness does not improve after 2-3 days I will consult my physician.

In consideration of my participation in this program, I hereby release Anna Chapman aka Anna Chapman, Body Love Yoga LLC, The Gem and their agents, the company, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the participation in said program, equipment and facilities as a result of my  voluntary participation and enrollment.

I acknowledge that my enrollment and subsequent participation in purely voluntary. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program. I accept and assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me or my guests and I, hereby fully and forever release and discharge Anna Chapman aka Anna Chapman, Body Love Yoga LLC, The Gem  and their agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including permanent disability and death.

I agree to be solely responsible for my safety and well being. I understand that the group exercise experience does not provide direct supervision, instruction, or assistance for exercise.

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS AND VOLUNTARILY SIGNED THIS WAIVER WITH FULL KNOWLEDGE OF ITS CONTENT.

First Participant's Name Name

First Name*

Last Name*

Phone*
First Participant's Name Date of Birth*
First Participant's Name Signature*
Second Participant's Name Name

First Name*

Last Name*
Second Participant's Name Date of Birth*
Third Participant's Name Name

First Name*

Last Name*
Third Participant's Name Date of Birth*
Fourth Participant's Name Name

First Name*

Last Name*
Fourth Participant's Name Date of Birth*
Fifth Participant's Name Name

First Name*

Last Name*
Fifth Participant's Name Date of Birth*
Sixth Participant's Name Name

First Name*

Last Name*
Sixth Participant's Name Date of Birth*
Seventh Participant's Name Name

First Name*

Last Name*
Seventh Participant's Name Date of Birth*
Eighth Participant's Name Name

First Name*

Last Name*
Eighth Participant's Name Date of Birth*
Ninth Participant's Name Name

First Name*

Last Name*
Ninth Participant's Name Date of Birth*
Tenth Participant's Name Name

First Name*

Last Name*
Tenth Participant's Name Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to be added to the Body Love Yoga Newsletter
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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