Check In Document and Liability Waiver

Full name:

Emergency Contact:

Date:

Phone :

Email Address:

Relation to you:

Food Allergies:

Location:

I am participating in classes and excursions offered by  Zunya, during which I will receive information and instruction. I recognize that it may require physical exertion, which 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 classes and excursions. I represent and warrant that I am physically fit and I have no medical conditions that would prevent my full participation.

(IMPORTANT: PLEASE NOTIFY YOUR INSTRUCTOR OF ANY PHYSICAL LIMITATIONS YOU MAY HAVE PRIOR TO EACH CLASS.)

In consideration of being permitted to participate, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating.

In further consideration of being permitted to participate in classes and excursions, I knowingly, voluntarily and expressly waive any claim I may have against Zunya, the owners and teachers for injury or damages that I may sustain as a result of participating.  

I also understand that Zunya is a development concept of hospitality and community, and as such there construction projects, tools and farm implements, uneven terrain, open fishponds, etc, that have the potential to cause harm, and promise and waive any claim I may have for injury or damages that I or my family may sustain as a result of being here.

I acknowledge that Zunya is not a health care provider and the classes and excursions are no substitute for medical diagnosis and treatment.

I, my heirs, or legal representatives forever release, waive, discharge and covenant not to sue Zunya, the owners and staff for any injury or death caused by their negligence or other acts.

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

Date: __________________  Signature:  ____________________________________________