Expressive Healing | Yoga for Healers Registration & Liability Waiver
Please complete this form before attending Yoga for Healers at Expressive Healing. Your registration confirms your understanding that this is a wellness-based yoga class and is not psychotherapy or mental health treatment.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Emergency Contact
Do you have any current injury, medical condition, physical limitation, pregnancy-related consideration, or other health concern that may affect your ability to safely participate in yoga?
Yes
No
If YES → Please briefly describe anything you would like the instructor to be aware of so that you can participate as safely and comfortably as possible. *Please remember that you are responsible for determining whether an activity is appropriate for you and for communicating with your instructor about modifications or concerns.
I understand that Yoga for Healers is a wellness activity and is not psychotherapy, counseling, mental health treatment, or crisis intervention. Participation does not create a therapist-client relationship between me and Expressive Healing or Adrienne Achille.
Expressive Healing Yoga Class Liability Waiver & Assumption of Risk
I understand that participation in yoga and related movement activities involves physical activity and inherent risks. These risks may include, but are not limited to, muscle soreness, strains, sprains, falls, dizziness, balance-related injuries, aggravation of existing injuries or medical conditions, and other physical injury or discomfort.I understand that yoga is not a substitute for medical care, physical therapy, or other professional healthcare services. I am responsible for determining whether participation in yoga is appropriate for me based on my individual health and physical condition. If I have concerns about participating in physical activity, I understand that I should consult an appropriate healthcare professional before participating.I agree to listen to my body and to modify, rest, or discontinue any activity that causes pain, dizziness, discomfort, or that I believe may be unsafe for me. I understand that I am responsible for informing the instructor of relevant physical limitations or concerns that may affect my participation.To the fullest extent permitted by applicable law, I voluntarily assume the risks associated with participation in this yoga class and agree to release and hold harmless Expressive Healing, Adrienne Achille, and any assistants or instructors involved in the class from claims arising from my participation, except to the extent liability cannot legally be waived or released.I understand that this waiver does not release any liability that cannot legally be released under applicable law.Emergency Medical CareIn the event of an emergency, I authorize reasonable emergency assistance to be sought on my behalf if I am unable to make or communicate such a decision myself. I understand that I am responsible for any medical expenses or costs associated with emergency or medical care.Wellness Activity — Not PsychotherapyI understand that Yoga for Healers is offered as a wellness and movement activity. It is not psychotherapy, counseling, mental health treatment, or crisis intervention.No therapist-client relationship is created through my participation in this yoga class. Information shared during the class is not intended to constitute a psychotherapy session or clinical treatment.By signing below, I acknowledge that I have read and understand this waiver, have had an opportunity to ask questions, and voluntarily agree to its terms.
Signature
I confirm that the information I provided is accurate to the best of my knowledge and that I am voluntarily participating in Yoga for Healers.
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