Chair Yoga Liability Waiver Form 
To participate in the Township Library of Lower Southampton's chair yoga classes (in-person and/or online) with instructor Shashi K.  Marda, you need to agree to the following liability waiver statements by completing and signing the form.

*Be aware that you will not be allowed to participate in class if you do not complete and sign a form. If you DISAGREE with any of these statements, DO NOT complete this form and DO NOT attend class.  

You are required to fill out this form once per calendar year. This form is in effect from the date it is signed (written or e-signature) through the remainder of the 2025 year. 
Sign in to Google to save your progress. Learn more
First Name  *
Last Name
 *
Home Address *
Phone Number *
Email Address
AGREEMENT - The participant's signature below confirms that they read this agreement, understood it, and agree to it. 
The opinions, services and instruction being offered to me by Shashi K. Marda, or other instructors at her request, are NOT medical advice, consultation, Therapy or treatment, nor does it include any other medical, mental, physical or spiritual diagnosis. I understand that the educational services and instruction provided by the instructors are not intended to be in place of or in lieu of any medical advice or treatment that I may require for any cause whatsoever, now or in the near future.  *
Required
No representations or statements that have been made to me in regards to the services or instruction that may be provided and NO GUARANTEE has been made to me in regards to expected results or a cure of any kind or for any medical condition, nor are any of the instructors considered or trained as such therapists.  *
Required
It is my responsibility to consult with a physician prior to and regarding my participation in the individual/group classes/workshops offered. I represent and warrant that I am physically fit and have no medical or mental condition which would prevent my full participation in classes, workshops, or instruction.  *
Required
Yoga requires physical exertion which may be 
strenuous and I specifically agree that Shashi K. Marda, all instructors, and any or all subordinate or affiliated people or organizations shall not be liable for any claim, demand, cause of any action of any kind, whatsoever for, on account of death, personal injury, property damage or loss of any kind resulting from or related to participant's use of facilities or participation in any sport, exercise, yoga, or activity within or without the facility premises. 
 *
Required
Engagement in any and all physical movement, exercises, or yoga is done at my own risk. I assume all risk and full responsibility of injury, illness, damage or loss to my person or property that might result.  *
Required
I understand that my behavior in class must be appropriate, otherwise I may be asked to leave.  *
Required
I, my heirs or legal representatives forever agree to release and discharge all instructors, employees, officers and agents of Shashi K. Mardi and their assigns from any and all claims or causes of action known or unknown arising out of any act or negligence arising from my participation in their courses. I acknowledge that I have read this AGREEMENT and fully understand its contents. 

Signature (write or type name*)

*By typing your name, you agree that this serves as a substitute for your written signature. If you would prefer to have a written signature, you need to come to the library to fill out a paper form in-person before you can attend class. 
 *
Date (Month/Day,/Year) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms