Class Liability Waiver And Release Form printable pdf download

Liability Waiver and Release Form

Name: ____________________________________________________________________D.O.B. ______________________

Address: _______________________________________________________________________________________________

City: ___________________________________________________________________ Zip: ___________________________

Phone: ___________________________________________Email: ______________________________________________

Emergency Contact Name: ___________________________________________________________________________

Emergency Contact Phone: __________________________________________________________________________

I understand that yoga includes physical movements and, as is the case with any physical

activity, the risk of injury, even serious or disabling, is always present and cannot be

entirely eliminated. If I experience any pain or discomfort, I will listen to my body, and

discontinue the activity immediately. I assume full responsibility for any and all damages,

which may incur through participation.

Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is

not recommended and is not safe under certain medical conditions. By signing, I affirm that

a licensed physician has verified my good health and physical condition to participate in

such a fitness program. In addition, I will make the instructor aware of any medical

conditions or physical limitations before class. If I am pregnant, become pregnant or I am

post-natal or post-surgical, my signature verifies that I have my physician's approval to

participate. I also affirm that I alone am responsible to decide whether to practice yoga and

participation is at my own risk. I hereby agree to irrevocably release and waive any claims

that I have now or may have here after against Mind Body Life Transformation Center,

PLLC, Karen Pascoe, and any, and all instructors and employees involved in this company.

I have read and fully understand and agree to the above terms of this Liability Waiver

Agreement. I am signing this agreement voluntarily and recognize that my signature serves

as complete and unconditional release of all liability to the greatest extent allowed.

Signature: _________________________________________________________ Date: ___________________________

Class Liability Waiver And Release Form