Adults and Minors Yoga Waiver Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact - Name*

First NameLast Name

Emergency Contact - Relationship with You*

Emergency Contact - Phone Number

Please enter a valid phone number.

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, is always present and cannot be eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation. 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 will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Zest and Zen and it's instructors. Zest and Zen and its instructors (Varsha Pangarkar and substitute instructors) also provide health coaching techniques other than yoga as part of lifestyle improvement. I understand that all such techniques have their own risks and I take full responsibility for any adverse consequences or lack of improvement that might happen as part of using such techniques. I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Texas.

I , hereby agree to the following:

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, is always present and cannot be eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation.
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 will make the instructor aware of any medical conditions or physical limitations before class.
If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk.
I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Zest and Zen and it's instructors. Zest and Zen and its instructors (Varsha Pangarkar and substitute instructors) also provide health coaching techniques other than yoga as part of lifestyle improvement. I understand that all such techniques have their own risks and I take full responsibility for any adverse consequences or lack of improvement that might happen as part of using such techniques.

I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Texas.

Signature of the Participant*

Signature of the Guardian- If the participant is a minor

Name of the Guardian

First NameLast Name

Date

If you consent to allow your photos or videos to be used for Yoga Purposes, please sign below: