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Roots Yoga

In consideration of & as inducement to my enrolling as a student of Roots Yoga, I represent and agree as follows:

(1) I have been examined by a licensed physician with in the past six months and have been found by such physician to be in good physical health and fully able to perform all yoga exercises which I am to learn and perform during my enrollment with Roots Yoga.

(2) I will faithfully follow all instruction given to me by instructors as to when, where, and how to perform and not to perform yoga exercises. It is understood that any deviation by me from such instruction shall be at my own risk.

(3) I will not hold Roots Yoga, your partners, instructors or employees responsible for any injuries suffered by me caused in whole or in part by my failure to faithfully follow the instructions of Roots Yoga or its instructors or by any physical impairment of mine in fully disclosed to you in writing.

(4) I understand and acknowledge that I am to receive instruction in yoga theory and exercise only and I will not hold Roots Yoga, your partners, instructors or employees to any higher standard of care than that applicable to school of yoga theory and exercises.

(5) In the event that I am pregnant, I will not attend a yoga class until I have discussed the risks with my obstetrician. I will follow my doctor's recommendations and will not hold Roots Yoga responsible for any injuries to myself or my fetus caused in part or in whole by my failure to follow my doctor's recommendation.

(6) In the event that I bring valuables into any Roots Yoga location or space in which Roots Yoga is holding an event, class, workshop or training, or leave valuables within my car at a parking lot, it is at my own risk. Roots Yoga is not responsible for lost or stolen items.

(7) Roots Yoga hosts events, classes, workshops and trainings at outdoor, public spaces. I realize that outdoor areas may have obstacles such as rocks, unleveled grounds and other hazardous materials that can cause an uneven surface and when I am in attendance of those events, classes, workshops or trainings, it is at my own risk.

(8) If I am under 18 years old, I have disclosed that information to Roots Yoga. In addition to my signature, my parent and/or guardian has signed and dated this waiver of liability at the bottom of this page.

Today's Date: May 21, 2019

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
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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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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