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WAIVER AGGREMENT
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* Indicates required question
Email
*
Your email
NAME (First & Last Name)
*
Your answer
DATE:
MM
/
DD
/
YYYY
ADDRESS:
Your answer
PHONE:
*
Your answer
Where did you find me? (Social media, friend, google)
*
Your answer
Why did you register for the class? or stretch/flex session (increase flexibility, strengthening, lose weight)
Your answer
HEALTH GOALS (what do you want target during private or nutritional coaching sessions. Please specify areas (hip, shoulders, hands, etc..)
*
Your answer
ANY INJURIES or Problem Areas
*
Your answer
WHAT ARE YOUR EXPECTATIONS
*
Your answer
YOGA/ STRETCH EXPERIENCE?
*
Your answer
Can we send you our FREE e-book to download on Mindful Eating and tools to help? Along with future promotional and emails. We promise not to bombard your email.
YES
NO
Option 3
N/A
I understand and agree to the following: I am participating in yoga classes during which I will receive information and instruction about yoga and mindfulness, as well as health. I recognize that yoga and mindfulness requires physical exertion, which may be strenuous and may cause physical injury and I am fully aware of the risks. YES- agree NO- don't agree
*
Yes
No
Required
I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga and mindfulness classes or stretch therapy. YES- agree NO- don't agree
*
YES
No
Required
I agree to assume full responsibility for any risks, injuries or damages, known, or unknown, which I might incur as a result of participating in yoga/mindfulness or any other activities. YES- agree NO- don't agree
*
Yes
No
Required
I knowingly and expressly waive any claim I may have against Curly Q Yoga, LLC for injuries or damages that I may sustain as a result of participating in yoga class/bootcamp/private/small group sessions. YES- agree NO- don't agree
*
YES
No
Required
Check for permission for photo release and/or video recording.
*
Yes
No
Required
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.
*
Yes
No
Required
NAME( PRINT) in agreement
*
Your answer
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