In consideration of and as an inducement to my enrollment and payment of fees to become a student of Olive Branch Yoga, I represent and agree as follows:(1) I (hereinafter “I” or “applicant”) have been examined by a licensed Physician within thepast six months and have been found by such physician to be in good health and fullyable to perform all yoga exercises which I am to learn and perform during my enrollmentwith Olive Branch Yoga.(2) I will faithfully follow all instructions given by Olive Branch Yoga instructors as to when and how to perform and not perform yoga exercises. I knowingly and willingly assume the risk of personal injury, disease, or death, whether known or unknown, from the practice ofyoga and group exercise activities. I take personal responsibility in taking care of my body and listening to what feels best while at Olive Branch Yoga. It is my responsibility to let the instructors know if I have an injury and or if I am needing guidance for modifications, to ask before class starts. (3) I understand and agree that I will receive instruction in yoga theory and exercise only and that I hold harmless Olive Branch Yoga, its employees, officers, directors, shareholders, and contract trainers for any damage to or theft of personal property on or away of Olive Branch Yoga premises, or personal injury, including but not limited to bodily injury, disease, disability, humiliation, or consequential loss of any kind arising out of my participation in any Olive Branch Yoga event or activity.(4) In the event that I am pregnant, I will not attend yoga class until I have discussed thepotential risks to my unborn child/fetus or me with my obstetrician. I agree that I will followmy obstetrician’s recommendations on behalf of myself, my heirs, spouse or otherinterested party holds harmless Olive Branch Yoga for any possible injury to myself or myunborn child/fetus.(5) If I am under 18 years of age, I warrant that I have disclosed my age to Olive Branch Yoga and in addition to my signature, have provided the signature of my parent or legalguardian below.(6) Registration fees and tuition for classes paid hereafter are non-refundable.(7) Any provision not in conformity with the laws of the State of Illinois is hereby severed from this agreement and the remaining provisions remain enforceable. Applicant agrees that any dispute regarding this agreement will first be tendered by parties to a member of The American Arbitration Association for resolution prior to filing of any lawsuit. Applicant also agrees, failing a successful arbitration effort, that the 21st Judicial Circuit Court of Kankakee County, Illinois shall be the sole and exclusive jurisdiction for any and all lawsuits,enforcement actions and/or causes of action concerning or related to this agreement.
I First Name Last Name understand that I am opting for an elective yoga class/classes that is not urgent and may not be medically necessary.I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact and through respiratory droplets when an infected person coughs, sneezes, or talks; and, as a result, federal and state health agencies recommend social distancing and face masks. I recognize that Olive Branch Yoga has put in place reasonable preventative measures aimed at reducing the spread of COVID-19, however, Olive Branch Yoga cannot guarantee that I will not become infected with COVID-19 through this elective class/classes/workshop. I understand and assume the risk of becoming infected with COVID-19 by virtue of proceeding with this elective yoga class/classes.I understand that, even if I have been tested for COVID-19 and have received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID-19 after the test. I understand that, if I have a COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective treatment may lead to a higher chance of complication and death.I understand that possible exposure to COVID-19 before/during/after my class/classes/workshop may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, possible need for intubation/ ventilator support, short-term or long-term intubation, other potential complications, and the risk of death. In addition, after my elective yoga class/classes/workshop, I may need additional care that may require me to go to an emergency room or a hospital.I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the treatment itself. I have been given the option to defer my treatment to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired yoga class/classes/workshop.
COVID-19 Risk Informed Consent