Yoga Student Release

This is a Waiver of Liability For Purple Lotus Wellness Yoga, LLC.

We require that all students sign this waiver before beginning classes with us. It helps us to be informed of any pre-existing conditions in order to protect you during our sessions. It also waives us from liablity if you were to sustain an injury in class. While these classes are often for all levels and a slower-paced yoga, you agree to participate of your own volition.

Health Declaration

Please fill out the following form
in order to participate in our session

First Name

Last Name

Date of Birth

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

Waiver

In consideration of and as inducement to my enrollment and payment of fees, I represent and agree as follows: I am in good health and can perform all yoga exercises with the exception of those stated above. I will faithfully follow all instructions given to me by authorized instructors as to when and how to perform and not perform yoga exercises. I understand the practice of yoga exercise activities may expose me to personal injury, disease, or death and I knowingly and willingly assume such risk. I understand and agree that I will receive instruction in yoga theory and exercise only and that I hold harmless Purple Lotus Wellness Yoga, LLC for any damage to or theft of personal property on or away from the premises, or personal injury, including but not limited to bodily injury, disease, disability, death, humiliation, or consequential loss of any kind arising out of my participation in any yoga practice. In the event that I am pregnant, I will not attend a yoga class until I have discussed the potential risks to me or my unborn child with my obstetrician. I agree that I will follow my Doctor’s recommendations and on behalf of myself, my heirs, spouse or other interested party hold harmless Purple Lotus Wellness Yoga, LLC for any possible injury to myself or my unborn child. *If I am under 18 years of age, I warrant that I have disclosed my age to Purple Lotus Wellness Yoga, LLC and in addition to my signature, have provided the signature of my parent or legal custodian or guardian below. Fees are non-refundable. Any provision not in conformity with the law of any state or governing body having jurisdiction is hereby severed from this contract and the remaining provisions remain enforceable.

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