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Waiver Yoga
WAIVER FORM
“You cant stop the waves, but you can learn to surf them”
- Jon Kabatt Zinn
Waiver Form
Name
(Required)
Address:
Phone Number:
(Required)
Email:
(Required)
Emergency Contact Name:
(Required)
Emergency Contact Ph No:
(Required)
Have you ever practiced Yoga before?
(Required)
Yes
No
If yes, for how long?
(Required)
Limitations/Injuries
(Required)
Do you have numbness/pain in any of the following:
(Required)
Neck
Shoulders
Elbows
Hands
Wrists
Hips
Lower Back
Upper Back
Knees
Feet
Other
Waiver: If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body and your teacher. I, the undersigned, understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will not perform any postures to the extent of strain or pain. I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class.
I agree to the terms above.
Those under 18 years of age must have this form signed by a parent or guardian.
Print Name:
(Required)
Get In Touch
Phone:
087 793 2547
Email:
[email protected]
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