Waiver for Virtual Yoga Class with Jessica Whetsel
Please take a moment to read and virtually sign this waiver, then answer the questions below.

LIABILITY WAIVER

I have been examined by a licensed physician within the past six months and have been found by such a physician to be in good physical health and fully able to participate in a yoga session.

I will faithfully follow all instructions given to me by Jessica Whetsel as to when, where, and how to adjust my body and how to not do so as well. I will not hold Jessica Whetsel or her partners, instructors, or employees responsible for any injuries suffered by me caused in whole or in part by my failure to faithfully follow their instructions or by any physical impairment of mine not fully disclosed to them in writing.

I understand and acknowledge that I am to receive instruction in yoga theory and exercise only and I will not hold Jessica Whetsel or her partners, instructors, or employees to any higher standard of care than that applicable to school of yoga theory and exercises.

In the event I am pregnant, I will not attend a yoga class until I have discussed the risks with my obstetrician. I will follow my doctor's recommendation and will not hold Jessica Whetsel responsible for any injuries to myself or my fetus caused in part or whole by my failure to follow my doctor's recommendation.

If I am under 18 years of age, I have disclosed that information to Jessica Whetsel. In addition to my signature, my parent and/or guardian has signed and dated this waiver of liability within the intake form.

I understand that Jessica Whetsel is not responsible for any of my personal items that are lost, damaged, or stolen while attending an event or class.

I hereby hold harmless and release and forever discharge Jessica Whetsel from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Sign in to Google to save your progress. Learn more
Email *
Do you accept the Liability Waiver above? *
What is your full name? *
What is your mailing address? *
Is this your first experience with yoga? *
Are you under the age of 18? *
Do you have any physical or emotional injuries at this time that would prevent you from practicing yoga? (Jessica Whetsel is not a licensed physician or therapist. Please ask your medical care team if it is recommended for you to practice yoga.) *
Is there anything else you would like to share about you and/or your previous experiences with yoga?
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy