Waiver Name * First Name Last Name Birth Date * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * I understand that yoga includes physical activity and, as with all physical activity, there is the risk of injury of varying types and degrees, which risk cannot be entirely eliminated. If I experience any pain or discomfort, I agree that I will discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages which may be incurred as a result of my participation in the yoga activities. I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment, nor is yoga recommended or safe under certain medical conditions. By signing, I affirm that a licensed physician has verified the status of my health and physical condition as sufficient to allow me to participate in the physical activity required by the yoga program. I agree that 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 my participation is at my own risk. I agree to irrevocably release and waive any claims that I have now or may have hereafter against The Yogiak, Amy Nelson, and its instructors. The yoga activities I engage in may be provided to me on line or by similar electronic, video, or digital means. I understand, acknowledge and accept that this type of activity may have disruptions in service, may be impacted by the nature and quality of the transmission, may not afford me the ability to see, perceive, or comprehend certain visual, audio, or physical cues, instructions, conditions, or other elements of the services provided by The Yogiak, Amy Nelson and/or may not provide you an opportunity or ability to perceive and/or render assistance in the event of an emergency or other situation that requires prompt or immediate attention. I understand that I have assumed the risk of such a situation and I will take steps to avoid or deal with such situations at my location, as well as providing to The Yogiak, Amy Nelson, such information I have regarding any condition that exists or I believe may arise during these yoga activities. I understand that participation in classes includes possible exposure to infectious diseases including but not limited to MRSA, influenza, and COVID-19. While there and may be established, either by governmental action, the studio, the instructor, or otherwise, certain rules, regulations, protocols, procedures and restrictions, as applicable to the studio, the instructor, and me, as the student, the purpose of which is to reduce the risk of infection, there is a risk of serious illness and death. I understand and freely assume this risk, as well as the responsibility of complying with all rules, regulations, protocols, procedures and restrictions, whoever or whatever established them. I knowingly and freely assume the risk of infection, even if it arises from the negligence of anyone else, including but not limited to the studio and the instructor, and I waive and release The Yogiak, Amy Nelson, as well as its staff, the instructor and any other person or entity involved in arranging, conducting, or providing any services in any way for the yoga session or instruction, regarding any claim, injury, disability, death, as well as any loss or damage to person or property, that might result from exposure to any communicable disease. I also understand and agree that, if I observe, become aware of, or in any way have or gain knowledge of any unusual or significant hazard during my presence or participation, including but not limited to the presence of any communicable disease, I will remove myself from participation and bring such to the attention of the instructor and/or nearest representative of the studio immediately. I also understand that, during the course of the yoga activities, you may receive in some form information about me that would be considered as confidential or protected, including but not limited to medical, financial and personal information. This would include any such information that may be communicated during or pursuant to yoga activities I engage in on line or by similar electronic, video, or digital means. I acknowledge that I have responsibility to protect and prevent the disclosure of any such information. 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 California. * I agree to the above Signature * (By accepting "I Agree" using any device, means, or action, you consent to the legally binding terms and conditions of this agreement. You further agree that your signature on this document is as valid as if you signed the document in writing) Date MM DD YYYY Thank you!
