Release and Waiver - Online Yoga Classes
By completing this form, you certify that you understand and accept any risks inherent in participating in live and/or online yoga classes.
Sign in to Google to save your progress. Learn more
Email *
List Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Phone Number
Comments - anything I should know about your health
How did you find Alissa Xander Wellness? *
Required
Disclaimer
Please consult your physician or other health care professional before starting this or any other fitness program to determine if it is right for your needs. Do not start this fitness program if your physician or health care provider advises against it. If you experience faintness, dizziness, pain, or shortness of breath at any time while exercising, you should stop immediately. Please always listen to your body and make any necessary modifications with your practice.

This site offers health and fitness information and is designed for educational purposes only. You should not rely on this information as a substitute or replacement for professional medical advice, diagnosis, or treatment. If you have any other concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid, or delay obtaining medical or health-related advice from your health-care professional because of something you may have seen or read on this site. The use of any information provided on this site is solely at your own risk.

You agree by attending an in-person class with Alissa Xander or utilizing these online yoga classes and fitness recordings that you do so at your own risk and assume the risk of any and all injury and/or damage you may suffer, whether while engaging in physical exercise or not. You assume the risk of your participation in any activity, class, program, instruction, or event, including but not limited to yoga. You agree that you are voluntarily participating in these activities and assume all risk of injury, illness, damage, or loss to you or your property that might result, including, without
limitation.

If at any time during yoga class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body and respect its limits on any given day.
I hereby agree to the following:
1. I am participating in classes or services during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any physical fitness program, including yoga. I represent and warrant that I have no medical condition that would prevent my participation in physical fitness activities.
3. In consideration of being permitted to participate in the yoga classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I might incur as a result of participating in the program.
4. In further consideration of being permitted to participate in the yoga classes, I knowingly, voluntarily, and expressly waive any claim I may have against the teacher, the owner, or the leaseholder of the building for injuries or damages that I may sustain as a result of participating in classes or workshops held at XYZen Wellness LLC.
5. That if I participate in other classes or events at XYZen Wellness LLC (such as fitness, dance, martial arts, etc.) that I will also assume full responsibility for any injuries that may result from my participation, with the same consideration that this waiver stipulates for yoga (items 1-4 above).
I
 have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

Today's Date *
MM
/
DD
/
YYYY
Please enter your initials *
Would you like to subscribe to emails to learn about events, healthy tips, get recipes, etc. from Alissa? *
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