* Esoteric Yoga practitioner refers to: Sandra Dallimore

MY CONSENT:

I understand that the Esoteric Yoga practitioner is not liable for any direct, indirect, special, incidental or consequential damages arising out of or in connection with my participation in an ESOTERIC YOGA session, now or later, including but not limited to personal or any other loss or damage caused to me while participating in an ESOTERIC YOGA session.

I agree to indemnify the Esoteric Yoga practitioner against all claims or liability whatsoever in respect of personal injury or any loss or damage caused to me arising out of or in connection with my participation in an ESOTERIC YOGA session.

If I should have any injury, disease, disability, mental health or other concern about my health or well being, now or later, I will consult my GP or other healthcare provider first before I participate or continue to participate in an ESOTERIC YOGA session.

If I am on any medication, prescribed or otherwise, or if I have been prescribed medication which I am not taking, I will consult my GP first before I participate in an ESOTERIC YOGA session.

If I experience any pain or difficulty during the ESOTERIC YOGA session, I will stop immediately and consult a doctor.

My participation in any ESOTERIC YOGA session is at my own risk.

MY CURRENT CONDITIONS:

Should I have any current illness or injury, however minor, I understand that it is my responsibility to make this known to  my practitioner prior to attending the session.  

I warrant that I am not currently and have never been clinically diagnosed with any of the following Mental Health Conditions:
- Schizophrenia / Bipolar and or states including Mania and Delirium / Psychosis / Borderline Disorder / Major Depressive Disorder.

I recognise and agree that this practitioner does not provide treatment or service to anyone with the above conditions and, if I have or have ever been diagnosed with any of the above conditions, I may not be treated by the practitioner.

By signing this form:

I acknowledge and agree that this practitioner reserves the right to decline any booking (including mine) for attendance at any session, now or later, or to ask any client (including me) to  leave any session at any time, for any reason they see fit.  

I certify that the information I have provided on the previous page is accurate and complete to the best of my knowledge and I have made full disclosure above of all my medical conditions, including current medications.

* By ticking CONSENT in the ONLINE CONSENT FORM (previous section) I agree to all of the above.