STUDENT REGISTRATION/CONSENT/LIABILITY WAIVER
FOR PARTICIPATION IN YOGA CLASS, WORKSHOP, EVENT, OR ACTIVITY
Please fill out this
form and submit it to your yoga teacher, by e-mail (preferred) or in person. (Please print)
Circle class registering
for: Special Event/Workshop - _________________________________________
Last name: __________________________________
First name: _________________________________
Address:
Email Address:__________________________________________________________________________
Phone:
Home: ___________________________ Cell: _____________________ _____________________
Emergency contact: __________________________________________
Phone: ______________________
If under 18 - Name of Parent(s)/Legal Guardian(s): ______________________________________________
NOTICE:
Any
sport or yoga can be a physically demanding activity. It is vitally important that you are in a physical condition that will allow
you to participate without presenting a danger to yourself or others. If you have any concerns that a health condition, injury or
previous lack of physical activity may put you at risk of personal injury or discomfort, please advise your yoga teacher. Before participating
in this or any exercise program, individuals should consult with a physician.
Individuals under eighteen (18) years of age must
have written consent/permission of their parent(s) or legal guardian(s).
VOLUNTARY PARTICIPATION
I, the undersigned, acknowledge
that I have voluntarily chosen and requested to participate in the yoga class, workshop, event, or activity (hereinafter referred
to as yoga class) sponsored by Carol Wallace.
ACKNOWLEDGEMENT
I am aware that participation in any sport or in yoga may result
in accident or injury, and I assume the risk connected with the participation in a sport, in yoga, or in activities related to the
instruction of yoga and I represent that I am in good health and suffer from no physical impairment which would limit my participation
in the yoga class. I acknowledge that Carol Wallace has not and will not render any medical services, including medical diagnosis
of my condition.
RELEASE
In consideration for being permitted to participate in the yoga class, I agree that I, my heirs, assignees,
guardians, and legal representatives will not make any claim against, sue, or attach the property of, any of the hosts, teachers,
organizers, or participants in the yoga class, including but not limited to Carol Wallace, her assistants and agents for injury or
damage resulting from my participation in such yoga class. I release all such hosts, teachers, organizers, and participants, their
agents and heirs, from any and all actions, causes of action, lawsuits, claims or demands that I, my assignees, heirs, guardians,
and legal representatives now have or hereafter may have for any and all injury, illness, death, loss of or damage to property associated
with my participation in the yoga class.
I have carefully read this agreement and fully understand its contents. I have signed
this release freely and voluntarily. I am aware and agree that it is a complete release of liability for any injuries or damages I
may sustain due to my participation in yoga classes, workshops, events and activities with Carol Wallace, her assistants and agents.
Note: If you are under the age of 18 years, your parent(s) or legal guardian(s) must sign on your behalf.
Dated at Moose
Jaw, Saskatchewan, this ____________ day of ____________________________, 201____
_________________________________________
Signature: