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Yoga Class Waiver Form
Registrant Details

Waiver:

If at any time during the class you feel discomfort or strain, gently come out of that posture. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day.

I, the undersigned, understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. 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 any serious illness or injury before every yoga class. I will not perform any postures to the extent of train or pain.

I accept that neither the instuctor, nor the hosting facility, is liable for any injury, or damages, to person or property resulting from the taking of this class.  Those under 18 years of age must have this form signed by a parent or guardian.
 

Date: September 28, 2022

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
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
Participant's 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.

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
Have you practiced yoga before?*
No
Yes

If yes, for how long:

Limitations/injuries:
Do you have numbness: Circle all that apply
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other

If Other:
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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