RYC Liability Waiver

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I, Client Name*, wish to participate in the exercise and training program offered by Stephanie Watson Lewis I understand there are inherent risks in participating in a program of strenuous exercise. Consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program within sixty (60) days of the date set forth below. No change has occurred in my physical condition since the date such approval was given which might affect my ability to participate in the fitness program. If a physician has not examined me, I agree to see a physician within sixty (60) days of the date set forth below to obtain his/her approval for my participation in a fitness program. I agree that Stephanie Watson Lewis shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge Stephanie Watson Lewis from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only an injury caused by the gross negligence or intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators, and assigns.

I agree not to hold Yoga Heart & Mind LLC/Stephanie Watson Lewis, or any of its affiliates liable for any injury or damages related to my participation in 1-on-1 sessions, in person classes, online classes, workshops, trainings, retreats or other activities.

I have read and understand this term.*

Yes

I certify that the answers to the questions outlined on the PAR-Q form are true and complete to the best of my knowledge. I acknowledge that medical clearance is required if I have answered “Yes” to any of the questions on the PAR-Q form. I understand and agree that it is my responsibility to inform the instructor of any conditions or changes in my health, now and on going, which might affect my ability to exercise safely and with minimal risk of injury.*

Yes

I understand that I am not obligated to perform nor participate in any activity that I do not wish todo, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform the instructor.*

Yes

I understand the results of any exercise program cannot be guaranteed and my progress depends on my effort and cooperation in and outside of the sessions.*

Yes

I understand that all private session rates are based on 30 or 50 minute sessions and should I arrive late, there is no guarantee I will receive the full session with the instructor. In return, if the instructor is late for a session, I will still receive the full session time.*

Yes

I understand that Yoga Heart & Mind LLC / Stephanie Watson Lewis operates on a scheduled appointment basis for all personal sessions and thus, requires that I provide 24 hours notice when canceling an appointment. No charge will be levied should I cancel with MORE than 24 hours notice given.*

Yes

I understand that during an exercise session, Yoga Heart & Mind / Stephanie Watson Lewis may have to use Touch Training to correct alignment and/or to focus my concentration on a particular muscle area to be targeted. If I feel uncomfortable or experience any type of discomfort with Touch Training, I will immediately request that the instructor discontinue using this technique.*

Yes

I understand that Yoga Heart & Mind / Stephanie Watson Lewis photographs many of her client events/sessions and I provide written approval for her to use these pictures for promotional purposes.*

Yes

I have read this Release and Terms of Agreement and I understand all of its terms. I sign it voluntarily and with full knowledge of its significance.

Signature:*

Today's Date:*

Date

Intake Form

Client Information Questionnaire