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Please complete this waiver prior to attending a class or training with the Kentucky Yoga Initiative. You will only need to complete the waiver once. 

I understand that yoga includes physical movements as well as an opportunity for stretching, strengthening, and deep relaxation. As is the case with any physical activity, I accept that the risk of injury is always present and cannot be entirely eliminated. I am fully aware of the inherent risks involved in this physical activity. I acknowledge that yoga is not a substitute for medical attention and it is not intended to examine, diagnose or treat any condition. I acknowledge that yoga may not be recommended or may not be safe for those with certain medical conditions. I acknowledge and affirm that I am competent to decide whether or not to participate in group or private yoga classes and I will make an informed choice before doing so. I understand that it is my responsibility to consult with a physician, if necessary to make an informed choice, prior to participation in any yoga class or training.

I Agree

 

In consideration for the opportunity to receive and participate in any yoga class or training, I unconditionally release and hold harmless Kentucky Yoga Initiative (KYI), as well as any other instructors, assistants, presenters, independent contractors, employees, volunteers, and representatives, against and for all liability, cost, expenses, claims and damages that I, my heirs or assigns, have now or hereafter may have by reason of any accidents or injuries to any persons, or damage to any property or both, in any manner arising or resulting from, caused by, connected with or related to the participation in yoga class or training, regardless of how, where, or when such damage occurs even if caused by the negligence or gross negligence of KYI, or associated instructors, assistants, presenters, independent contractors, employees, volunteers, and representatives.

I Agree

 

I give KYI express permission to take photos and videos of me, and to use those photos and videos for marketing purposes.

I Agree

 

………………………..

 

Coronavirus/COVID-19 Addendum:

 

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. In consideration for the opportunity to receive and participate in a yoga class or training, I unconditionally release and hold harmless KYI, as well as any other instructors, assistants, presenters, independent contractors, employees, volunteers, and representatives, against and for all liability, cost, expenses, claims and damages that I, my heirs or assigns, have now or hereafter may have arising out of or relating to COVID-19, regardless of how, where, or when such damage occurs even if caused by the negligence or gross negligence of KYI, or associated instructors, assistants, presenters, independent contractors, employees, volunteers, and representatives.

I Agree

 

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 Information

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
First Participant's Signature*
Second Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Third Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Fourth Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Fifth Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Sixth Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Seventh Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Eighth Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Ninth Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
Tenth Participant's Name

First Name*

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

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

To help with programming demographics please list the mailing address zip code of the participant below. 


Zip Code
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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