ILW Waiver & Release Form Leave this field blank First name Last name Date Of Birth What's your age? Choose 20-24 25-29 30-34 35-39 40-44 45-49 50+ Phone Number E-mail Emergency Contact Name & Number What's your level of practice? beginner or 1st class ever intermediate advanced How did you hear about Infinite Life Yoga Would you like to get emails that include tips, tricks, and upcoming information on offerings? YES NO Any past or present conditions, injuries, surgeries, or inhibitions: What services are you interested in? Please select all that apply. Private Yoga Yoga for Mothers Online Yoga Classes Family Yoga Therapeutic Yoga Couples Yoga Yoga Workshops In Person Yoga Other Is there anything else you want me to know? 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 I Heart Yoga and it's instructors. By my signature below, I certify that I am physically able to practice yoga and do hereby agree that Janelle Gordon (Infinite Life Works, Infinite Yoga) and/or any instructor at Infinite Life Works is not responsible or liable to me for any injury, accident or loss of personal property. I do hereby release Janelle Gordon (Infinite Life Works, Infinite Yoga) and its’ employees and students from any claim or cause of action which may have occurred as a result of any medical problem known or unknown which I have knowledge presently or in the future. I verify no promises or guarantees, other than those written in this agreement were made to me by Janelle Gordon (Infinite Life Works, Infinite Yoga) or its’ employees, contractor, and students. I agree to follow the instructional guidelines presented by Janelle Gordon (Infinite Life Works, Infinite Yoga). 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 fifty states of The United States of America. I HAVE READ AND AGREE TO THE TERMS ABOVE I DO NOT AGREE TO THE TERMS ABOVE Send
