Yoga in the Park Waiver Today's Date * MM DD YYYY Your Name * First Name Last Name Email * City * State * Emergency Contact Information Name * First Name Last Name Phone * (###) ### #### Relationship I am Parent/Guardian (If 18 years or younger): I have read the above release and waiver of liability and fully understand its contents. As Parent/Guardian, I voluntarily agree to the terms and conditions stated above for the individual listed below. Parent / Guardian Signature and Date: Child's Name First Name Last Name Relationship Electronic Agreement * I hereby agree to the following: That I am participating in yoga with Carrie Asby of Bilancia Yoga (here in after referred to as the “Carrie”) during which I will receive information and instruction about yoga and related exercise. I recognize that yoga and related exercise requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the yoga classes. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in yoga classes. I also acknowledge that it is my responsibility to inform her when an adjustment has gone as far as I desire at that time. If my position on being touched has changed, it is my responsibility to communicate this this her. In further consideration of being permitted to participate in yoga classes, I knowingly, voluntarily, and expressly waive my claim I may have against Carrie for injury or damages that I may sustain during or as a result of participating in yoga classes. I, my heirs, or legal representative, forever release waive, discharge and covenant not to sue Carrie Asby for any injury or death caused by negligence or other acts. Carrie is not responsible for any personal belongings I bring to or leave at the location of the yoga class. I agree to let Carrie use any photograph and video taken at this event for any marketing or informational purpose they deem suitable. I agree to receive email from Carrie. I understand I am free to opt out of emailings at any time. I confirm that I have read and understood the content of this document. By clicking the Submit button, I acknowledge that I am electronically signing this document. I consent to the use of electronic communications and records related to this document. Terms and Conditions Privacy Policy I hereby acknowledge that I have read and understood the above conditions. Thank you!
