Yoga, AcroYoga & Massage Waiver

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

City*

Occupation

Emergency contact*

Name

Emergency Phone Number*

Please enter a valid phone number.

How did you heard about me?*

Would you like to receive occasional emails?*

YesNo

Are you comfortable to receive physical adjustments and massage during the class?*

YesNoOther

Do you practice exercises/ sports? Is yes, please list:

Please list any injuries, medical issues or important medical history:

By signing this waiver, I agree and understand the following:

1. The practice of Yoga, AcroYoga and Massage has certain hazards and risks and it requires physical exertion that may cause physical injury.

2. I am aware that is recommended to consult with a medical physician before joining a class, workshop, or any session.

3. In case instructors provide physical adjustments, I understand that I have the option to opt out by letting my instructor know my wish not to have physical adjustments.

4. I hereby release, waive, discharge and hold harmless the instructors, institution, staff, volunteers, affiliates, and partners from any liabilities arising from any untoward incident in my participation in any class, workshop, and relevant sessions which may result in injury, loss, damage, or death.

By signing this form, I represent and warrant that I am physically fit and capable of participating in Yoga, AcroYoga and Massage classes, workshops, or activities. I agree and legally bind myself, fully understanding the contents and meaning of the provisions above. I declare that I am over 18 years of age and fully capable of giving my consent.

Please have a parent or guardian sign if you are under 18 years old.

Type your full name to sign *

Date*

Date

If you haven't paid, save your spot by sending an e-transfer to

atmaflow@gmail.com