Adoration Yoga Student Liability Release

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Adoration Yoga Student Liability Release

Please fill out this form completely before you participate in an Adoration Yoga class and or event.

Learn more about Adoration Yoga's Christ-centered classes at www.AdorationYoga.com.

Email any questions to Sarah Brown at adorationyoga.co@gmail.com

Email *

First Name *

Last Name *

Phone number *

Emergency contact *

Emergency contact's phone number *

Have you ever participated in yoga before? *

Yes

If yes, how often?

List any medical restrictions or conditions that your instructor needs to be aware of:

I hereby affirm myself to be physically sound and suffering from no condition, ailment, or impairment, disease or other illness that would prevent my participation in yoga classes and activities. I declare that I have disclosed any and all medical history to Adoration Yoga LLC and/or their affiliates relevant to participation.

(Initial below)

I hereby consent as a participant in yoga classes with Adoration Yoga LLC and agree to assume all of the risks involved. I understand that Adoration Yoga LLC does not provide medical insurance relative to accidents, injuries, and/or death as a result of program related activities; and that I can not hold Adoration Yoga LLC or its affiliated teachers personally responsible for any liability.
(Initial below)

I recognize that any form of physical activity is potentially hazardous one, and that they involve a risk of possible injury or even death. I hereby affirm that I am voluntarily participating in these activities with knowledge of risk involved. I agree to expressly assume and accept any and all risks of injury and/or death occurring to me as a result of my participation in the activity.

(Initial below)

I recognize by participating in yoga classes, that photos and/or videos may be taken. I grant to Adoration Yoga LLC the irrevocable and unrestricted right to use and publish photographs and video (“Media”) which I may be included, for editorial, trade, advertising, and any other purpose and in any manner and medium. I hereby release Adoration Yoga LLC their legal representatives and assigns from all claims and liability relating to said Media. (Initial below)
*

Our teachers are certified to use physical touch for therapeutic purposes and posture adjustments. I am aware that it is my responsibility to inform my teacher of my personal preferences toward or against physical contact. (Initial below)
*

Participant Digital Signature

(Type your name)

Parent/Guardian Digital Signature if participant is under the age of 18

(Type your name)

YYYY

A copy of your responses will be emailed to the address you provided.

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