Release and Waiver of Liability

Name______________________________________

Address______________________________________

City___________________ State_____ Zip Code_________

Home Phone___________________ Work Phone___________________

E-Mail______________________________________

Limitations or Injuries______________________________________

In An Emergency Contact______________________________________

How did you discover us?______________________________________

FOR PRE-/POST-NATAL CLASSES ONLY:

Doctor's Permission (must be obtained prior to attendance of class): _________________________________________ is my patient and has no medical restrictions in participating in this pre-natal yoga class.

Date___________________________

Doctor's Name________________________________________________

Doctor's Signature_____________________________________________

Phone Number________________________________________________

I ____________________________, am participating in yoga classes or workshops at Yoga Salah, I am aware of the physical risks involved with strenuous exercise and understand it is my personal responsibility to consult with my Doctor regarding my participation. I have no medical condition, which would prevent me from taking part in yoga classes or workshops, and I assume responsibility for any risk or injury I may sustain as a result of my participation. I have read the above release and waiver of liability and understand its contents. I agree to the terms and conditions stated above.

 

___________________ ______________________________________
Date Signature of participant