Combined Coaching and Yoga Liability and Waiver Form

Client Name*

First NameLast Name

Gender*

FemaleMaleOther

Date of Birth*

Date

Phone Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Relationship to Emergency Contact*

Have you ever been diagnosed with a medical condition or mental illness?*

YesNo

If you answered Yes above please provide details.

Are you currently taking any medication?*

YesNo

If you answered Yes above please provide details.

Are you currently working with any other medical professionals? Please specify.*

Have you ever worked with a counsellor or coach before? If Yes, what was your experience?*

Choose 3 words to describe your personality:*

3 areas that are a priority for you right now:*

If I had all the power in the universe to change one thing about your life right now, what would it be?*

Is there anything else you think I need to know about you that may assist tailoring your sessions? For example, health concerns, additional needs, disabilities, significant life events, etc. If not, just write 'None'*

Have you practised yoga before?*

YesNo

Yoga Level*

BeginnerIntermediateAdvanced

Are there any injuries or physical limitations that may restrict your practice? E.g. Pregnancy, back injury etc*

YesNo

If you answered Yes above please provide details.

What is your main reason for coming to class?*

Is there anything else you think I need to know about you that may assist tailoring your classes? If not, just write 'None'*

Terms and Conditions

1. Schedule of Fees - The client’s investment is non-refundable. Fees will be invoiced and required to be paid prior to the scheduled session. Each session will run for approximately 1.5 hour unless otherwise agreed.

2. Cancellation Policy - When it is foreseeable, the client agrees to give no less than 24-hours notice to reschedule a yoga or coaching session.

I understand that yoga includes physical movements. As is the case with any physical activity, the risk of injury is always present and cannot be avoided entirely even though all care is taken by the teacher to eliminate risk. If I experience pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher.I understand that I assume full responsibility for any risks, injuries or damages known or unknown, that I might incur as a result of participating in the yoga class or coaching session. As such, I agree that the teacher/coach is not responsible for any actions or inactions taken, or for any direct or indirect results from services provided.I understand that yoga and coaching is not a substitute for medical advice, examination, diagnosis or treatment and that the teacher/coach is not a doctor. Yoga and coaching is not recommended or safe under certain medical conditions. I understand it is my responsibility to consult with a medical professional prior to and regarding my participation in the yoga class or coaching session.I understand that all information supplied by the student is confidential, unless the teacher/coach deems the student to be in a serious or life-threatening situation, in which case the teacher has a duty of care to report such information to the appropriate authorities.I understand that there will be moments of exploration, reflection, transformation, connection and fun during the yoga class and coaching session. I will ensure I don’t push myself beyond what is comfortable and will seek out assistance from the teacher/coach where needed.I understand that by signing this form, I am acknowledging that all information I have provided is true and correct. I acknowledge I have read, clearly understood and accepted the above waiver of liability.

Client Signature*

Must be signed by a legal guardian if client is under 18 years of age.

Date Signed*

Date

Combined Coaching and Yoga Liability and Waiver Form

Medical Background

Knowing You Better For Coaching

Knowing You Better For Yoga

Agreement and Consent