Yoga Liability Form for Rebecca Rizzuto / Seva Living

Street Address

City, State, Zip

Phone Number

Your Custom Text Here

Agreement of Release and Waiver of Liability

This form covers all classes offered by Rebecca Rizzuto/ Seva Living and affiliated studios.

Name

First Name

Last Name

Birthdate

YYYY

Preferred Gender Pronoun

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

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Emergency Contact Name

Emergency Contact Phone

(###)

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Please fill in your name and agree by checking off each paragraph below: I,

hereby agree to the following:

That I am participating in Yoga, Fitness and other classes, Workshops, or other programs offered by Rebecca Rizzuto/Seva Living, during which I receive information and instruction about healthy and safe practice. I recognize that these classes and workshops may require physical exertion, which may be strenuous and could result in serious 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 Classes, Workshops and Therapies. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in these Classes, Workshops & Therapies. (Doctor’s release may be required)

I agree to assume full responsibility and liability for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the yoga class/workshop. I agree to inform my instructor of any physical limitations, physical discomfort and/or injuries before or during classes, and I take full responsibility for nondisclosure.

In further consideration of being permitted to participate in Classes, Workshops, Programs & Therapies, I knowingly, voluntarily and expressly waive any claim I may have against Rebecca Rizzuto/Seva Living for any and all injuries or damages that I may sustain as a result of participating in this class/workshop, including death.

I have read the above release waiver of liability and fully understand its contents. I voluntarily agree to its contents. I voluntarily agree to the terms and conditions stated above.

If participant is under 18: As legal guardian of

I consent to the above terms and conditions.

Signature

This Acknowledgement and Certification of Understanding ("Acknowledgement") is to let you know that by submitting an electronic signature, you are providing an electronic mark, that is held to the same standard as a legally binding equivalent of a handwritten signature provided by you. For purposes of the acknowledgement, a digital mark is considered a typed legal First and Last name (legal name may include middle name, initial or suffix) followed by the typed date. Any document requiring an electronic signature may contain a signature acknowledgment statement provided in the same area requiring the electronic signature.

Date

YYYY