Health & Harmony Yoga Waiver

Health & Harmony
320 Main Street
Princeton, TX 75407
RELEASE OF LIABILITY - YOGA
Name: ________________________________________________________
Telephone: ______________________________________________________
Address: ______________________________________________________
City: ________________________________ State: __________________
Zip: ________________________
E-mail address: ___________________________________________________
Medical Alert (injuries, physical limitations, ailments, etc.)
_______________________________________________
_______________________________________________
_______________________________________________
How did you hear about Health & Harmony?
____________________________________________________
Participation in Yoga classes may include, but is not limited to, participation in meditation techniques, yogic breathing
techniques, and performing various Yoga postures. Yoga postures, or asanas, are designed to exercise every part of the
body - stretching and toning the muscles and joints, the spine and the entire skeletal system. They also work on the
internal organs, glands and nerves. Yoga incorporates sustained stretching to strengthen muscles and increase flexibility.
Yoga and physical exercise is an individual experience. I understand that in Yoga, and in any other exercise class, I will
progress at my own pace. If at any point I feel overexertion or fatigue, I will respect my own body's limitations and I will
rest before continuing Yoga or any other exercise.
By signing my name below, I acknowledge that participation in Yoga classes or any other exercise class exposes me to a
possible risk of personal injury. I am fully aware of this risk and hereby release Sabina Health dba Health & Harmony,
Amanda Blair, City Center Properties, and / or any other persons who may teach at Health & Harmony, from any and all
liability, negligence, or other claims, arising from, or in any way connected, with my participation in Yoga and any other
exercise class.
My signature further acknowledges that I shall not now, or at any time in the future, bring any legal action against Sabina
Health dba Health & Harmony, Amanda Blair, City Center Properties, and / or any other persons who may teach at Health
& Harmony; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my
successors and my assigns.
My signature verifies that I am physically fit to participate in Yoga classes, or any other exercise classes, and a licensed
medical doctor has verified my physical condition for participation in this type of class.
If I am pregnant, or become pregnant, or am post-natal, my signature verifies that I am participating in Yoga, or any other
exercise classes, with my doctor's full approval.
I realize that I am participating in Yoga, or any other exercise classes, at my own risk.
My signature is binding to this liability waiver from this day forth.
Date _________________________
Signature ________________________________________

---

IF UNDER 18 YEARS OF AGE
As legal guardian of ________________________________, we consent to the above conditions.
Signature of Guardian: _______________________________
Informed Consent and Waiver of Liability
I understand that Yoga, Pilates, Personal Fitness Training, Tai Chi, and any other exercise program can be physically
intensive, and I voluntarily assume the risk inherent in my participation in exercise classes at Health & Harmony, including
the risk of injury, accident, death, loss, cost or damage to my person or property. I release and indemnify Health &
Harmony from, and against, any and all such claims and liabilities, including attorneys' fees.
I further attest that I am in sufficient physical health, and/or that I have consulted with a physician and I am able to
undertake and engage in the physical movements and exercises in classes that I have chosen to take at Health &
Harmony.
I assume responsibility to update Health & Harmony of any changes in my medical condition that might affect my safety or
participation in any classes at Health & Harmony.
Signature _________________________________________________
Date _______________________

---