In consideration of the yoga practice offered, it is hereby understood and agreed as follows:
I recognize the risks of possible injury in any exercise program, and I am participating in the fitness program with the express agreement that I hereby waive and release Jen Stone Yoga, Flourish Fitness & Yoga (d/b/a Freedom to Flourish, LLC), any instructors, and any of its staff, employees, or agents from any and all claims, suits, causes of action and any liabilities caused by illness, damage, or injury arising out of my participation in the fitness program(s).
I specifically waive any and all claims that I may have arising out of personal injury and/or property damage resulting from participation in the program(s) and waive my rights against Jen Stone Yoga, Flourish Fitness & Yoga (d/b/a Freedom to Flourish, LLC) or any instructor, agent, employee, and any of its staff, employees or agents from any claims.
I further understand and represent that I have consulted my physician or health-care provider and I am physically capable of participating in such an exercise program without injury.
I acknowledge that I have been specifically warned of the special risk associated with participating in any exercise programs for individuals whose weight exceeds recommended maximums or whose general physical condition make personal injury or illness more likely to result from physical activity, including yoga.
I also understand that I am to be aware of the necessity of wearing appropriate clothing in participation of this program.
I hereby execute and deliver the Waiver and Release as a condition of my being permitted to participate in the fitness program. (Please Print Clearly)
Name________________________________________________ Birthdate _______________________________
Signature____________________________________________ Date_____________________________________
Email Address_________________________________________________________________________________
Address_______________________________________City___________________State_____ Zip___________
Phone_____________________________________ How did you hear about JSY?____________________
Emergency Contact Name__________________________________Phone___________________________
Thank You!
