Life in Abundance TSI Yoga Waiver
Please fill out the waiver below.
Name (first and last) *
Phone Number *
Email *
Address *
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor? *
Do you feel pain in your chest when you do physical activity?  *
In the past month, have you had chest pain when you were not doing physical activity?  *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by change in your activity? *
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
Do you know of any other reason why you should not do physical activity? *
Whole FitnessRelease of Liability Form: Under the consideration of being allowed to participate in the fitness training activities of Whole Fitness and its program of Revelation Fitness and to use the facilities, equipment, and services, in addition to the payment fee of any charge, I do hereby forever waive, release and discharge Whole Fitness and its officers, agents, employees, representatives, executors, and all others acting on their behalf from any and all claims or liabilities for injuries or damages to my person and or/property, including those caused by the negligent act or omission of any of those mentioned or other acting on their behalf, arising out of or connected with my participation in any activities, programs or services of Whole Fitness and the use of any equipment at various sites, including home, provided by and/or recommended by Whole Fitness.  I have been informed of, understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment, are potentially hazardous activities. I also have been informed of, understand and am aware that fitness activities involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the damages involved. I hereby agree to expressly assume and accept any and all risk of injury or death. I do hereby further decree myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in these activities or use of equipment or machinery. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in the exercise activities, programs, and use of exercise equipment. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physicians as to physical activity, exercise and use of exercise equipment. I acknowledge that I have either had a physical examination and have been given my physician’s permission to participate OR I have decided to participate in the exercise activities, programs and use of equipment without the approval of my physician and do hereby assume all responsibility for my participation in said activities, programs and use of equipment. I understand that Whole Fitness and its programs, in providing and maintaining an exercise/fitness program for me, do not constitute an acknowledgement, representation, or indication of my physiological wellbeing or medical opinion relating thereto. *
What are you hoping to gain from taking this class? *
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