Informed Consent & Liability Waiver [onhermat.com]

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I am delighted to welcome you as a student with Santosha Yoga Culture in Lagos, Nigeria.
The following information will help you get the most out of your Yoga classes and clarify the instructor/student relationship. All information is confidential and will not be shared with anyone else.

Email *

Full Name *

Age *

Name of Organization (Corporate Training Only)

Taking stock of 2023, what lessons did you note about yourself, how did you grow? What are the habits you want to GIVE UP and the habits you want to KEEP in 2024? *

Taking stock of 2023, what resisted you from creating good habits and what enabled you and kept you motivated? *

Taking stock of 2023, how do you want to be supported by your teacher? *

Have you practiced Yoga before? *

YES

If YES, how long have you been practicing?

Do you have numbness/pain in any of these areas? *

Neck

Shoulders

Elbows

Hands

Wrists

Hips

Lower back

Upper back

Knees

Feet

None of the above

Other:

Required

Scale of 1-5 (1 is the lowest) what is your current level of fitness? *

Scale of 1-10 (1 is lowest) how would you rate your level of stress presently? *

What are your current Yoga interests? *

Asana (physical practice) - strength, flexibility, relieve pain, balance

Pranayama (breath work) - sleep better, improve focus, release trauma

Meditation (mental reset) - clarity, body awareness, relaxed mind, stress managemnt

Yoga Alignment and Cues (tailored poses) - reduce risk of injury, stable foundation

Advanced Yoga Poses - headstand, Splits, handstand, deep backbends, etc

Sports Enhancement - tennis, football, cycling, running, etc

Learning Sequences for Personal Practice

Other:

Required

Please state any Limitations / Injuries/ Health concerns that might affect your practice of yoga (check with your doctor if you need to)

I understand that Yoga sessions may produce side effects such as muscle soreness, increased awareness of areas of pain and light headedness among other TEMPORARY outcomes. *

YES

I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of this class. *

YES

I understand that Yoga is not a substitute for medical attention. examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognize that it is my responsibility to notify my teacher of any serious injury or preexisting conditions. I will not perform postures to the extent of strain or pain. I will listen to my body, and respect its limits on any given day. *

YES

If you chose to set your Intention: SET YOUR RESOLVE TO DO IT HERE; FIRST BY REPEATING IT MULTIPLE TIMES TO YOURSELF, AND THEN WRITING IT IN YOUR JOURNAL 3 TIMES. "I __________ commit to practicing __________ consistently each month. I choose this practice because of positive benefits like - [I deserve this time to get to know myself, I want a stronger body, etc] I can do this. I will do this. I plan to continue on this course with love and trust, knowing that I am supported."

We set Intentions by saying affirmations to reprogram the subconscious mind, to encourage us to believe certain things about ourselves or about the world and our place within it. To help us create the reality we want, often in terms of making (or attracting) wealth, love, beauty, and happiness.

Imagine December 31st 2024, as you reflect on the last year, what words, feelings, or values are alive in your heart? *

Send me a copy of my responses.

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