Yoga Informed Consent Form

Client's Name

First NameLast Name

Client's Phone Number

Please enter a valid phone number.

Client's Email

example@example.com

Client's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age

Date of Birth

Date

Gender

MaleFemaleOther

If below 18 years old (minor), please enter name of parent or guardian

First NameLast Name

Parent / Guardian Phone

Please enter a valid phone number.

Have you done yoga or any workout program before?

YesNo

If yes, can you please provide more details?

Do you have any physical disability or any health issues/conditions that we should be aware of?

YesNo

If yes, please provide more details.

Do you have any of the following?

Are you pregnant? (For female)

YesNo

I, First NameLast Name of legal age would like to participate in a yoga class, meditation, sound and vibration therapy being offered by Lila Yoga & Wellness. I fully understand that yoga, meditation, sound and vibration therapy can be physical activity that may or may not cause physical injury. I agree to declare any health issue, conditions I may have before signing up for the program. A physician's recommendation should be provided before the yoga class begins. In the event that poses might be uncomfortable, any suggested modification can be discussed to me directly in a respectful manner. If there's any strain or fatigue, I can come out of the pose to rest and understand that each and every one has its own physical limitations. I fully recognize that any injuries sustained from all the physical activities will be my responsibility. Therefore I release Lila Yoga & Wellness of any liabilities. I have read and fully understand the terms of the agreement/waiver and accept all of it.

Client Signature

Date Signed

Date

Date Signed

Date

Yoga Informed Consent Form

Consent Agreement