Prana Yoga & Wellness YYC
Waiver
Date
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Name
First Name
Last Name
How did you hear about us?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
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Area Code
Phone Number
Gender
Male
Female
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Emergency Contanct
Emergency Contact Phone Number
Date of Birth
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Which service are you interested in receiving?
Please Select
Yoga
Mindfulness Coaching
Both
Yoga
If you are looking to start a yoga practice, please fill in the following section.
I acknowledge that I have read throught the following terms and conditions.
Acknowledgment of Risk-I understand that yoga includes physical movement, breathwork, and meditation techniques. As with any physical activity, I recognize that there is a risk of injury, including but not limited to muscle strain, sprains, or more serious conditions. I affirm that I am voluntarily participating in yoga classes or private instruction offered by Prana Yoga & Wellness YYC.
Health Conditions-I confirm that I am physically fit and have consulted with a medical professional regarding any conditions that could affect my ability to participate in yoga. I agree to inform the instructor of any injuries, medical conditions, pregnancy, or other concerns that might affect my safety during practice.
Personal Responsibility-I understand that it is my responsibility to monitor my own physical and emotional well-being during class. I will listen to my body and not push into pain or discomfort. I accept full responsibility for my participation and any outcomes resulting from it.
Not a Substitute for Medical Advice-I understand that yoga instruction is not a substitute for medical treatment or advice. [Instructor Name] is not a licensed healthcare provider and does not diagnose or treat medical conditions.
Release of Liability-I hereby release, waive, and discharge [Instructor Name / Business Name] from any and all liability, claims, demands, or causes of action that may arise as a result of my participation in yoga instruction. This includes claims of negligence, personal injury, property damage, or any harm I may suffer.
Communicable Illnesses-I acknowledge the contagious nature of communicable illnesses, including COVID-19, and voluntarily assume the risk of exposure by participating in in-person classes. I agree not to attend class if I am experiencing symptoms of illness or have tested positive for a contagious disease within the recommended isolation period.
Cancellation & Refund Policy-I understand and agree to abide by the class or session cancellation policy set by [Instructor Name], including any applicable fees for late cancellations or no-shows.
Consent to Participate-I have read and fully understand this waiver and release. I acknowledge that I am signing it voluntarily and am of sound mind to do so.
Photography & Social Media-I give permission for photos or videos taken during class to be used for marketing and social media purposes.
Mindfulness Coaching
If you are looking to start a yoga practice, please fill in the following section.
I acknowledge that I have read throught the following terms and conditions.
Nature of Services-I understand that the mindfulness coaching services provided by Prana Yoga & Wellness YYC are intended to promote personal awareness, wellness, and stress reduction through techniques such as meditation, breathwork, visualization, gentle movement, and reflective practices. I understand that these sessions are not a substitute for medical, psychological, or psychiatric care.
Voluntary Participation-I acknowledge that my participation in mindfulness coaching is entirely voluntary. I take full responsibility for my physical, mental, and emotional well-being during each session.
Health Disclosure-I affirm that I have disclosed any relevant medical or psychological conditions that might affect my participation. I agree to inform my coach of any changes to my health or circumstances that could impact my ability to safely engage in sessions.
Not Therapy or Medical Advice-I understand that mindfulness coaching is not therapy, counseling, or medical treatment. My coach is not a licensed therapist or healthcare provider and does not diagnose, treat, or prescribe for any medical or psychological conditions.
Assumption of Risk-I understand that, as with any activity involving mental and emotional exploration, there are potential risks. These may include emotional discomfort, fatigue, or the surfacing of unresolved feelings. I assume full responsibility for any risks or outcomes associated with my participation.
Confidentiality-I understand that all personal information shared in sessions will be kept confidential, except in cases where disclosure is required by law (e.g., risk of harm to self or others, child abuse).
Cancellation Policy-I agree to give at least 24 hours notice if I need to cancel or reschedule an appointment. I understand that late cancellations or no-shows may incur a fee.
Release of Liability-I hereby release and hold harmless Prana Yoga & Wellness YYC, its agents, employees, and representatives from any and all claims, liability, damages, or costs arising from my participation in mindfulness coaching sessions.
Consent to Participate-By signing below, I acknowledge that I have read and understood this waiver in full. I consent to participate in mindfulness coaching sessions under the terms stated above.
Waiver
Students under 18 years of age must have this form signed by a parent or guardian.
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