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Waiver for individuals participating in Yoga classes with Affirmations & Innovations LLC.

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. Asana (yoga posture) means posture easily held. If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body and inform my teacher immediately. I, the undersigned, understand that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I should consult a physician prior to beginning any activity program, including yoga. I recognize that it is my responsibility to notify my teacher of pregnancy, any serious illness or injury before every yoga class. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Affirmations & Innovations LLC, CrossFit Cholla, Fit 6-7-8 or any teacher affiliated with Affirmations & Innovations LLC. I also grant permission to Affirmations & Innovations LLC and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Affirmations & Innovations LLC and its legal representatives for all claims and liability relating to said images or video. Those under 18 years of age must have this form signed by a parent or guardian.

 

First Clients Name

First Name*

Middle Name

Last Name*

Phone*
First Clients Date of Birth*
First Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
First Clients Signature*
Second Clients Name

First Name*

Middle Name

Last Name*
Second Clients Date of Birth*
Second Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Third Clients Name

First Name*

Middle Name

Last Name*
Third Clients Date of Birth*
Third Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Fourth Clients Name

First Name*

Middle Name

Last Name*
Fourth Clients Date of Birth*
Fourth Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Fifth Clients Name

First Name*

Middle Name

Last Name*
Fifth Clients Date of Birth*
Fifth Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Sixth Clients Name

First Name*

Middle Name

Last Name*
Sixth Clients Date of Birth*
Sixth Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Seventh Clients Name

First Name*

Middle Name

Last Name*
Seventh Clients Date of Birth*
Seventh Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Eighth Clients Name

First Name*

Middle Name

Last Name*
Eighth Clients Date of Birth*
Eighth Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Ninth Clients Name

First Name*

Middle Name

Last Name*
Ninth Clients Date of Birth*
Ninth Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Tenth Clients Name

First Name*

Middle Name

Last Name*
Tenth Clients Date of Birth*
Tenth Clients Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
Clients 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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Participant's Email Address
Have you ever participated in yoga before?*
No
Yes
Is the participant comfortable with the teacher providing yoga pose adjustments with light touch?*
No
Yes

Please list any current or past injuries of which we should be aware.
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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