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Waiver For Yoga
Below please find the necessary waiver for attending one of my yoga classes at the 1 E. Benton, Aurora location, the Naperville Salt Cave or the 4 E Wilson, Batavia location. You can either copy the waiver and bring it to class already signed or arrive a few minutes early to fill out when you get to class. This waiver is only needed once per student regardless of location(s).
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Inspired by Earth Yoga with Sandra
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
Name:_____________________________________________
Date of Birth: ___________________________
Address:______________________________________________________________________
City:________________ State:____________ Zip Code: ______________
Email:_____________________________________ Phone: ____________________________
Name/Phone of Emergency Contact: _______________________________________________
Do you have any physical limitations that could be aggravated by exercise (i.e. back, neck,
shoulder or knee problems)? If so, please explain:_____________________________________
_____________________________________________________________________________.
It is your responsibility to inform the instructor of your limitations before class begins.
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation.
Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Sandra Coyner, The Support Companies (building owner), Healing Arts Metaphysical, Naperville Salt Cave and contracted instructors.
I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Illinois.
Print name: ________________________________
Signature:_____________________________ Date Signed:_______/_______/_______
If participant is under 18:
As Parent or Legal Guardian of ________________________________. I consent to the above
terms and conditions. Print name: ________________________________
Signature:_____________________________ Date Signed:_______/_______/_______
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
Name:_____________________________________________
Date of Birth: ___________________________
Address:______________________________________________________________________
City:________________ State:____________ Zip Code: ______________
Email:_____________________________________ Phone: ____________________________
Name/Phone of Emergency Contact: _______________________________________________
Do you have any physical limitations that could be aggravated by exercise (i.e. back, neck,
shoulder or knee problems)? If so, please explain:_____________________________________
_____________________________________________________________________________.
It is your responsibility to inform the instructor of your limitations before class begins.
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation.
Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Sandra Coyner, The Support Companies (building owner), Healing Arts Metaphysical, Naperville Salt Cave and contracted instructors.
I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Illinois.
Print name: ________________________________
Signature:_____________________________ Date Signed:_______/_______/_______
If participant is under 18:
As Parent or Legal Guardian of ________________________________. I consent to the above
terms and conditions. Print name: ________________________________
Signature:_____________________________ Date Signed:_______/_______/_______
