Personal Information & Liability Waiver Agreement
All new students MUST complete and sign this form prior to participation in their first class.
STUDENT INFORMATION:
Email *
First Name: *
Last Name: *
Phone Number: *
Mailing Address: *
Date of Birth: *
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Emergency Contact Name & Phone Number: *
What are your primary goals for practicing with us? *
What forms of exercise have you actively participated in in the last 5 years? *
Please list any current medical conditions, physical injuries or limitations that we should know about before class. *
WAIVER AND RELEASE OF LIABILITY
I understand that yoga includes physical activity and, as with all physical activity, there is the risk of injury of varying types and degrees, which risk cannot be entirely eliminated. If I experience any pain or discomfort, I agree that I will discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages which may be incurred as a result of my participation in the yoga activities. I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment, nor is yoga recommended or safe under certain medical conditions. By signing, I affirm that a licensed physician has verified the status of my health and physical condition as sufficient to allow me to participate in the physical activity required by the yoga program. I agree that 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 my participation is at my own risk. I hereby release The Yoga Space, LLC and its principals, agents, instructors, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in these activities, including those which may be attributed to the negligent acts or omissions of these parties. I understand and confirm that this agreement is binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement remains in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with The Yoga Space, LLC to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility as deemed necessary by The Yoga Space, LLC for the well being of the child.

I understand that participation in classes includes possible exposure to infectious diseases including but not limited to MRSA, influenza, and COVID-19. While there are and may be established, either by governmental action, the studio, the instructor, or otherwise, certain rules, regulations, protocols, procedures and restrictions, as applicable to the studio, the instructor, and me, as the student, the purpose of which is to reduce the risk of infection, there is a risk of serious illness and death. I understand and freely assume this risk, as well as the responsibility of complying with all rules, regulations, protocols, procedures and restrictions, whoever or whatever established them. I knowingly and freely assume the risk of infection, even if it arises from the negligence of anyone else, including but not limited to the studio and the instructor, and I waive and release The Yoga Space, LLC, as well as its staff, the instructor and any other person or entity involved in arranging, conducting, or providing any services in any way for the yoga session or instruction, regarding any claim, injury, disability, death, as well as any loss or damage to person or property, that might result from exposure to any communicable disease.

I also understand and agree that, if I observe, become aware of, or in any way have or gain knowledge of any unusual or significant hazard during my presence or participation, including but not limited to the presence of any communicable disease, I will remove myself from participation and bring such to the attention of the instructor and/or nearest representative of the studio immediately.

I also understand that, during the course of the yoga activities, you may receive in some form information about me that would be considered as confidential or protected, including but not limited to medical, financial and personal information. I acknowledge that I have responsibility to protect and prevent the disclosure of any such information.

I acknowledge that any photographs and/or video footage taken by The Yoga Space, LLC are the property and copyright of The Yoga Space, LLC and can be used for the purposes of promoting and publicly acknowledging the relationship.

The photographs and/or video footage may be used for the following:
Brochures
Advertising
Web site
Studio Recordings
Annual Review and Reports and
Other publications

INDEMNIFICATION:

I recognizes that there is risk involved in the types of yoga exercise activities offered. Therefore I accept financial responsibility for any injury that I may cause either to me or to any other participant due to my conduct, whether such be negligent or otherwise. Should The Yoga Space, LLC, or anyone acting on its or their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless The Yoga Space, LLC, its or their principals, agents, instructors, employees, and volunteers from liability for the injury or death of any person(s) and/or damage to property that may result from my conduct, whether negligent or otherwise, while participating in the yoga exercise activities offered, regardless of nature, duration, or location.
I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am completing this agreement voluntarily and recognize that my checking "I agree" serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Wisconsin. *
Påkrævet
Today's Date: *
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If the participant is UNDER the age of 18:
Parent/Guardian Name:
As the parent or legal guardian of the child named above, I hereby give my full consent and approval for my child to participate. By checking "I agree" I recognize my understanding and complete acceptance to the terms in this agreement.
Today's Date:
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Denne formular blev oprettet inden for The Yoga Space, LLC. Rapportér misbrug