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                              Yoga Agreement of Release and Waiver of Liability Form 

 Name 

Home Phone
Cell Phone:
Home Address
Email
Date of birth DD/MM/YY 

Emergency contact name and number
Have you practiced yoga before and if so how long? 

What injuries, limitations or disabilities do you currently have or have had in your past medical history that your instructor should be aware of? (For example joint/muscular/spine injuries, asthma, diabetes, blood pressure, heart/circulatory, pregnancy, recent surgery etc.) 

If you have any injuries, limitations or disabilities do you have your doctors consent to practice yoga? By completing and signing this form, I hereby agree to the following: 

That I am participating in a Yoga Class, Workshop, Event or Session Classes offered by Inner Dance Yoga during which I will receive information and instruction. I recognize that I will be required to participate in some physical exertion, which may be strenuous and may cause physical injury and I am fully aware of the risks and/or hazards involved. 

1. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Class, Workshop, Event or Session Classes. I certify that I am physically fit and I have no medical condition, which would prevent my full participation. 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 any program at Inner Dance Yoga. 

2. I knowingly, voluntarily and expressly waive any claim that I may have against Inner Dance Yoga  and its directors, owners, staff and instructors, for any injury, death or damages that I may sustain as a result of being in the aforementioned facilities or as a result of participating in a Yoga Class, Workshop, Event or Session Classes; including loss that may be caused by the negligence of the released parties including the loss, theft or damage of any of my personal property while at the Inner Dance Yoga facility. 

3. I have read the above release and waiver of liability and fully understand its contents. I am 18 years of age or older and voluntarily agree to the terms and conditions stated above. 

Participant signature: ______________________________ Date: __________________ ❖ If the participant is under 18 years of age: As a legal guardian of:_____________________________________, I consent to the above conditions and terms. 

Signature of parent/guardian: _________________________ Date: ___________________