Yoga Waiver Form - Bene Integrative Therapies

Yoga Waiver

Personal Details

Full Name

Date of Birth

Email Address

Contact Number

Emergency Contact Details

Next of Kin Name

Relationship to Participant

Contact Number

Medical History

Please indicate if you have ever experienced any of the following:

Please provide details for any checked items

Current Physical Condition

Informed Consent & Liability Waiver

I acknowledge the need to listen to my body during the yoga class and to adjust my participation based on any physical discomfort or limitations I may experience. I understand 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.
I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the yoga class. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the yoga class.
I agree to take full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the yoga class. Furthermore, I knowingly, voluntarily, and expressly waive any claim I may have against the yoga instructor, the studio, and its owners, for injury or damages that I may sustain as a result of participating in the class.

Confirmation

I have carefully read and fully understand and agree to the above terms of participation in the yoga class.

Confirm Name

Confirm Date