Student Information Sheet Template Page 2
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1
2RELEASE AND INDEMNITY
RELEASE AND INDEMNITY
AGREEMENT
AGREEMENT
I, ______________________________, in consideration of
I, ______________________________, in consideration of
my participation in yoga instruction, agree to release Mindy
my participation in yoga instruction, agree to release Mindy
Shulfer RYT and the Winsted Arts Council from all
Shulfer RYT and the Winsted Arts Council from all
actions, claims, expenses and demands in respect to injury,
actions, claims, expenses and demands in respect to injury,
loss or damage in connection
loss or damage in connection
with my participation.
with my participation.
I waive any and all claims against the above-mentioned
I waive any and all claims against the above-mentioned
party for any personal injuries that I may sustain or which
party for any personal injuries that I may sustain or which
may arise out of my learning, practicing, or participating in
may arise out of my learning, practicing, or participating in
yoga instruction.
yoga instruction.
I understand that the proper physical condition and health
I understand that the proper physical condition and health
insurance required to participate in this specific program is
insurance required to participate in this specific program is
my personal responsibility. I therefore am participating at
my personal responsibility. I therefore am participating at
my own risk.
my own risk.
If I have questions regarding this agreement, I agree to ask
If I have questions regarding this agreement, I agree to ask
those questions before I sign this agreement.
those questions before I sign this agreement.
By signing this agreement, I am declaring that I fully
By signing this agreement, I am declaring that I fully
understand its contents and agree to its terms.
understand its contents and agree to its terms.
(Signature)_____________________________
(Signature)_____________________________
DATE:________________________
DATE:________________________
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