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New Student Questionnaire & Waiver

Please complete this before attending your first yoga class

Thank you so much!

Brittany
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Your name  *
Email
 *Is it okay for us to send occasional emails about upcoming events, free classes, or class changes?
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Cell phone number
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Emergency Contact Information *
Have you previously attended a yoga class? *
If yes, how long have you practiced?
On a scale from 1 - 10, how physically active is your lifestyle? (10 being the most active)
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What other forms of movement/exercise do you do?

What aspects of yoga are most appealing to you?

Check all that apply.
What are your goals and expectations from your yoga class?

The following information is required to ensure your safety.

While yoga may be practiced safely by the majority of people, there are certain conditions which require special attention. If you are unsure please consult your doctor before attending class. Some conditions may require specific modifications to your yoga practice.

Do you have any of the following? *
Required
Do you have any old injuries that still trouble you? *
Are you currently pregnant? *
If any of the above applies, please explain.
Any other medical conditions not covered above that might be adversely affected by yoga practice? If so, please provide details.
 *
Anything else you'd like me to know?

I confirm the above information is correct. I understand that it is my responsibility to: 

• check with my doctor if I have any difficulties or concerns about my ability to participate in the yoga class.

• advise the yoga teacher of any change in my medical information or ability to participate in the class.

• follow the advice given by my doctor and/or yoga teacher.

• care for my own health and safety whilst participating in the yoga class, whether face to face or remotely.

• remain on screen when participating in a remote Yoga session. (I understand that for any periods of time throughout a remote session during which I move off screen or are outside of the teacher’s view, whether intentionally or not; no liability will arise on the part of the teacher.

By checking the box below, you are agreeing to the statement above. Please include today's date.


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Required
Student Waiver
Printed version will be at in person classes to sign as well.

  1. YOGA TEACHER LIABILITY

    STUDENT WAIVER AGREEMENT



    I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re education and relief of muscular tension. Participation in yoga class includes, but is not limited to, participation in meditation techniques, yogic breathing techniques, and performing various yoga postures. Yoga postures, or asanas, are designed to exercise every part of the body―stretching and toning the muscles and joints, the spine and the entire skeletal system. They also work on the internal organs, glands and nerves. Yoga incorporates sustained stretching to strengthen muscles and increase flexibility. Yoga is an individual experience.

    As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. My signature acknowledges I understand that in yoga class I will progress at my own pace. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the yoga teacher (Brittany Gundrum). I will continue to breathe smoothly. If at any point I feel overexertion or fatigue, I will respect my body’s limitations and I will rest before continuing yoga practice.

    Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. By signing my name below, I acknowledge that participation in yoga classes exposes me to a possible risk of personal injury. I am fully aware of this risk. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident and/or illness during any yoga class.

    I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows: I (a) irrevocably WAIVE, RELEASE AND DISCHARGE FROM ANY AND ALL LIABILITY for my death, disability, personal injury, property damage, property theft or actions of any kind which hereafter may occur to me, including my traveling to and from yoga classes, led by Brittany Gundrum, who is hosting these classes and where sessions are being held, and each of their directors, officers, employees, volunteers, representatives and agents; and (b) INDEMNIFY, HOLD HARMLESS AND AGREE NOT TO SUE the entities or persons mentioned in this paragraph as to any and all liabilities or claims made as a result of participation in the yoga classes, whether caused by the negligence of releasees or otherwise.

    My signature further acknowledges that I shall not now or at any time in the future bring any legal action against Teacher, Brittany Gundrum; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns. My signature verifies that I am physically fit to participate in yoga classes and a licensed medical doctor has verified my physical condition for participation in this type of class.

    If I am pregnant or become pregnant or am post natal, my signature verifies that I am participating in yoga classes with my doctor’s full approval. I realize that I am participating in yoga classes at my own risk.

    The Student Waiver Agreement shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I acknowledge that this Student Waiver Agreement form will be used by the persons or entities being released in the yoga classes and that it will govern my actions and responsibilities in said classes.

    I hereby certify that I have read this document; and, I understand its content. I am aware that this is a release of liability as well as a contract and I sign it of my own free will. I also understand at the yoga classes or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purposes by the Teacher.

By checking the box I am stating that I understand and agree to the terms explained above.
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