Participant Waiver & Release of Liability
Please complete all required fields before participating in any Rocks & Chakras class.
Name
First Name
Last Name
Email Address:
example@example.com
Phone Number:
Format: (000) 000-0000.
Emergency Contact Name:
Phone:
Format: (000) 000-0000.
Medical Conditions, Injuries, Accessibility Needs, or Other Information (optional):
Waiver & Assumption of Risk
By checking the acknowledgment box and submitting this form, I agree to the following:
I understand that participation in yoga classes involves physical activity that may include stretching, balance work, strength exercises, breathing techniques, meditation, and other movement practices. There are inherent risks that cannot be completely eliminated, including but not limited to muscle strains, sprains, falls, dizziness, aggravation of existing conditions, and other injuries. I represent that I am physically able to participate or have consulted an appropriate healthcare professional regarding my participation.
I am voluntarily participating in these activities and accept full responsibility for monitoring my own physical condition.
I understand that it is my responsibility to inform the instructor of any medical conditions, injuries, limitations, pregnancy, or accessibility needs that may affect my participation. I understand that the instructor is not a physician, physical therapist, or other licensed healthcare provider, and that these classes are not intended to diagnose, treat, or cure any medical condition.
To the fullest extent permitted by applicable law, I voluntarily assume all risks associated with my participation and release and hold harmless Rocks & Chakras, its instructors, the property owner or venue, and their representatives from claims arising from my voluntary participation, except where prohibited by law. I authorize emergency medical care if I am unable to provide consent and such care is deemed necessary.
I have read and agree to the waiver above.
(OPTIONAL) I give permission for Rocks & Chakras to use photographs or video of me taken during classes for promotional purposes.
Participant Signature:
Date:
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Month
-
Day
Year
Date
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