Aerial Yoga Liability Waiver and Registration Form

Aerial Yoga Liability Waiver and Registration Form
NAME*

FirstLast
DATE OF BIRTH*

DayMonthYear
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL*
PHONE*
EMERGENCY CONTACT NAME/PHONE*
Are you pregnant? *

YesNo
Please list any previous or chronic injuries here:
Permission to post pictures on social media*

YesNo
WHAT TO KNOW before coming to class:
• Come dressed in comfortable clothing that is free of sharp objects. No exposed zippers, snaps, or rhinestones as these can snag and rip our fabric hammocks.
• Remove all jewellery such as necklaces, bracelets, rings, and watches before class.
• No playing or practicing on the aerial hammocks (unless otherwise specified) until the instructor is present and the class is in session.

By signing this form, I release Akasha Aerial Yoga, Studio Sangha, and the staff of these establishments from any responsibility or liability for any personal injury sustained while participating in this activity.
I understand that use of the equipment and participation in this activity may result in serious injury, aggravation of pre-existing conditions, disability, paralysis or even death. Such events may result from equipment failure and/or any activity, whether difficult or not.
I am aware of my own health and physical condition and I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said activity.

Please submit payment to:

Andra Whipple

01-0867-0225050-05

Please use your name as reference.
How did you hear about us

Facebook/InstagramFriends/Word of MouthOther
DATE*

DayMonthYear
Date
Signature of participant (or parent/guardian if under 18)*

Clear
Should be Empty: