"Yoga with Goats"Agreement of Release and Waiver of Liability

Goat Yoga Fundraiser at Rock Chapel Ranch

Thank you for joining Eagles Nest for our Goat Yoga fundraiser at Rock Chapel Ranch! We’re excited to spend a relaxing and fun morning with you—and some very friendly goats.

By participating in this event, you are helping support mental health services in our community. Rock Chapel Ranch has generously committed to donating 50% of all registration fees to our charity to help provide accessible therapy and support services at low or no cost to those in need.

To learn more about our services, please visit - eaglesnestwaterdown.ca

We will see you soon!

Date and Time:
Saturday, July 18 and the session begins promptly at 10:30 AM

Address:
373 Rock Chapel Rd. Dundas *if you can, please carpool with your friends as parking is limited

What to Bring:
Yoga mat and Water

Registration:
To secure your spot, please complete Rock Chapel's Liability Form below (one per person) and send an e-transfer of $35 to kafka@rockchapelreanch.com. Please include “Eagles Nest July 18” in the notes with your e-transfer payment.

Please Note:
All purchases are final sale and refunds are not available. In the event of inclement weather, the class will be rescheduled.

Name

First NameLast Name

Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Mobile Phone

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date

Email Address

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Do you have any of the following conditions that your instructor should be aware of? Asthma, heart/circulatory problems, dizzy spells/fainting, pregnancy, high or low blood pressure, diabetes, epilepsy, neck/back/spine injury (ankle, knee, hip elbow, shoulder), muscular injury, or other medical condition/injury or disability?

If yes, which of the following conditions should your instructor be aware of:

Muscular Injury

Other medical condition/injury or disability

By completing and signing this form, I hereby agree to the following:

1. That I am participating in a yoga class, workshop, or pre-registered yoga session instructed by Vanessa Janko CYI or another CYI, during which I will receive information / instruction about Yoga. I recognize that yoga may require some physical exertion, which may be strenuous and may cause physical injury. I am fully aware of the risks and /or hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Class, Workshop, or Pre-registered yoga session. I certify the I am physically ﬁt and have no medical condition, which would prevent my full participation in the Yoga Class, Workshop or Pre-registered yoga session.

3. I agree to assume full responsibility for any risks, injuries or damages, known which I might incur as a result of participating in any yoga program at said locations (373 Rock Chapel Rd. Dundas, Ontario), including the presence of goats and alpacas, etc.

4. I knowingly, voluntarily and expressly waive any claim that I may have against said location, the owners of this property (Calvin and Sheryl Kafka) and instructor Vanessa Janko, (or other CYI) for any injury, death or damages that I may sustain as a result of participating in a goat yoga Class, Workshop Pre-registered yoga session; including loss that may be caused by the negligence of the released party.

5. I, my heir or legal representative, forever release, waive, discharge and convenient negligence or other acts. I have read the above release and waiver of liability and fully understand its contents. I am 18 years of age or older and voluntarily agree to the terms and conditions stated above.

Participant Signature (or Guardian if under 18)

Appearance/Photo Release

Participant understands that he / she, their child, and/ or family may or may not be photographed by Rock Chapel Ranch while participating in Yoga with Goats. As such, participants give Rock Chapel Ranch the right to use their image for the purpose of marketing platforms, websites and promotional materials for advertising. I understand I will not be compensated in any way for the use of my image.

Participant Signature (or Guardian if under 18)

Session Payment

In order to secure your spot in the "Yoga with Goats" for Eagles Nest session, a $35 payment must be sent by e-transfer to kafka@rockchapelranch.com. Please include “Eagles Nest July 18” in the notes with your e-transfer payment.

By signing below, you understand that your spot in the session is not reserved until payment is received by Rock Chapel Ranch.

Participant Signature (or Guardian if under 18)

Goat Yoga Fundraiser at Rock Chapel Ranch