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By participating in this yoga/movement class with Clarkston Yoga hereby agree to the following:

  1. That I am participating in the Yoga Classes & Training offered by Clarkston Zen during which I will receive information and instruction about Yoga and health. I recognize that Yoga involves physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
  2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Class & Trainings with Clarkston Zen. I represent and warrant that I am physically fit and I have no medical condition, which would prevent my full participation in the Yoga Class.
  3. In consideration of being permitted to participate in the Yoga Class & Training, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the class, training, or program.
  4. In further consideration by participating in the Yoga Class, I knowingly, voluntarily and expressly waive any claim I may have against Insert your Clarkston Zen for injury or damages that I may sustain as a result of participating in the class, training or program.
  5. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue for any injury or death caused by their negligence or other acts.
  6. I understand that It is my responsibility to verbally let the Instructor know if I have any injuries that would prevent me from being adjusted or if I am uncomfortable for any reason being adjusted.
  7. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.


Precautionary Coronavirus Liability Release

Due to the outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitization and disinfecting practices. Please complete the following and sign below.

Symptoms of COVID-19 include:

  • Fever
  • Fatigue
  • Dry cough
  • Difficulty breathing
  • Chills
  • Nausea or vomiting
  • Diarrhea
  • Confusion
  • New widespread muscle pain
  • Headaches
  • Red or purple toes
  • Loss of taste & smell
  • Bruising, redness, swelling, or cramping in lower legs and feet I, agree to the following:


  •  I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
  •  I affirm that I, as well as all household members, have not been diagnosed with COVID- 19 within the last 30 days.
  •  I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
  •  I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.
  •  I understand that this business and my massage therapist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.
  • By signing below I agree to each above statement and release the massage therapist and business from any and all liability for the unintentional exposure or harm due to COVID-19.
  • Your massage therapist or yoga instructor and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitization protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.




First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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:*
Emergency Contact

First Name*

Last 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*

Middle 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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