Student Waiver

Name of Participant *

First Name Middle Name Last Name

Birth Date *

Month Day Year

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

Mobile Number *

Area Code Phone Number

Would you like to subscribe to our email list? *

Yes No

Would you like to receive our text message reminders? *

Yes No

Workout Disclaimer: I hereby consent I am voluntarily participating in yoga in an in-person and/or virtual yoga class and agree to assume all risks involved. I understand that Firmly Planted, LLC, Laurie Hugdahl, and YogaFaith does not provide medical insurance relative to accidents, injuries, and/or death as a result of my voluntary participation in in-person and/or virtual yoga classes and I cannot hold Firmly Planted LLC, Laurie Hugdahl, YogaFaith or affiliated instructor(s) responsibly for any liability. I recognize that any form of physical activity that I voluntarily participate in could be a potential risk and that it involves a risk of possible injury or even death. I hereby affirm that I am voluntarily participating in these activities whether in in-person and/or virtual yoga classes with the knowledge of the risk involved. I agree to expressly assume and accept any and all risk of injury and/or death. I hereby affirm myself to be physically sound and suffering from no condition, aliment, impairment, disease, or other illness that would prevent my participation in in-person and/or virtual yoga classes. I declare that I have disclosed any and all medical history to Firmly Planted LLC, Laurie Hugdahl, YogaFaith and/or their affiliates to relevant to participate in in-person and/or virtual yoga classes. *

I agree

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. Asana (yoga postures) should be postures that are easily held. If at anytime during the class I feel discomfort or strain, I will gently come out of the posture. I may rest at anytime during the sequence. As is the case with any physical activity comma the risk of injury, even serious or disabling, is always present and cannot be entirely illuminated. If I experience any pain or discomfort, I will listen to my body and stop performing the yoga sequence immediately. I, undersigned, understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. Yoga is not recommended and is not safe under certain medical conditions. I should consult a physician prior to beginning any activity program including yoga. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Firmly Planted LLC, Laurie Hugdahl, or any teacher affiliated with Firmly Planted LLC. *

I agree

Those under 18 years of age must have this form signed by a parent or guardian. *

I agree

Do you have any physical or emotional concerns that could be aggravated by exercise (i.e. back, neck, shoulder or knee problems, arthritis, autoimmune disease, asthma, chronic disease/disability, PTSD, trauma). If yes, please explain: *

Photography & Video Disclaimer: I hereby authorize Firmly Planted, LLC, Laurie Hugdahl and/or YogaFaith to publish photographs and/or videos taken of me at Firmly Planted Wellness in-person and/or virtual yoga classes for use in printed, online, marketing, and video-based marketing materials, as well as any other publications. I release and hold harmless Firmly Planted LLC and Laurie Hugdahl from any reasonable expectation of privacy or confidentiality associated with the images and/or videos specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs/videos or participation in company marketing materials or other publications. I acknowledge and agree that publication of said photos and/or videos confers no rights of ownership or royalties whatsoever. I hereby release Firmly Planted LLC, Laurie Hugdahl, its contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation. *

I agree

Signature of Participant or Parent/Guardian if under 18

Clear

Student Registration Form