Empower Yoga New Liability Waiver

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Please fill this out and return before your first session.

Email *

First Name *

Last Name *

Date of Birth *

YYYY

I recognize and acknowledge that there is a known risk of injury and illness in utilizing the facilities and equipment at Empower Yoga, LLC., including but not limited to participating in individual or group fitness programs. *

Yes

Required

I recognize and acknowledge that coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing. Empower Yoga, LLC has put in place preventative measures to reduce the spread of COVID-19 for their classes; however, Empower Yoga, LLC cannot guarantee that you will not become infected with COVID-19. I am attending class at my own risk. *

Yes

Required

I recognize and acknowledge that I shall use Empower Yoga, LLC’s facilities, equipment and services in a responsible manner and in compliance with all applicable rules and practices, and will report immediately any injuries and accidents that may occur to him/her in, on or about the Empower Yoga, LLC premises to the Empower Yoga, LLC management. Empower Yoga, LLC is not responsible for the loss of personal property. *

Yes

Required

I am participating at my own risk and knowingly and voluntarily assume full responsibility for any injury, illness or harm that may occur to me on or about the Empower Yoga, LLC premises. I hereby hold harmless and fully and forever releases and discharges Empower Yoga, LLC and all associated businesses, its trustees, employees and agents from any and all claims, liabilities, debts, losses, expenses, attorneys' fees, demands, rights of action, or causes of action, present or future, whether known, anticipated or unanticipated, resulting from, arising out of or incident to my use or intended use of Empower Yoga, LLC, and any of its facilities, equipment or services. *

Yes

Required

I have read and understand the statements above. *Please sign your full name *

Enter today's date *

YYYY

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