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Yoga4U - The Yoga & Reiki Studio
Name *
Birthdate *
Email *
Address *
Phone number *
Are you fully vaccinated? *
Emergency Contact Name *
Emergency Contact Number *
How did you hear about us?
Are you affected by any of the following?
Column 1
Neck/Back problems
Shortness of breath
High blood pressure
Low blood pressure
Heart condition
Bone/Joint damage
Epilepsy or Seizure
Are you pregnant?
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If you ticked any of the above, please provide further details. Please describe in detail any other health or medical condition that you believe may be helpful for your yoga teacher to know: *
Are you currently on medication? If Yes, pls describe. *
In-Studio Group Class Fees: (Taxes Included)
Column 1
$18 - Drop-in One class
$55/2 Weeks Unlimited(New Member Only)
$105/10 Classes/Month
$130/15 Classes/Month
$145/20 Classes/Month
$165/Unlimited/Month (Max.1 class/day)
$130/10 Classes/3 months (Quarterly)
$160/15 Classes/3 months (Quarterly)
$180/20 Classes/3 months (Quarterly)
$200/30 Classes/3 months (Quarterly)
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Class Start Date *

Inherent Risks:

You must be fully vaccinated to participate in any and all in-studio activities at Yoga4U. You are required to provide proof of vaccination to attend in-studio classes. If you are fully vaccinated and contract COVID-19, Yoga4U as a studio, including teachers, are not responsible. It is your responsibility to keep yourself and others safe.

If you are not fully vaccinated, you are not permitted to attend in-studio classes. However, you may attend our parallel online classes.

By signing this disclaimer/liability waiver, in addition to the Covid-19 liability waiver, you are agreeing to follow our studio policy, and the COVID-19 protocols at your own risk.

I assume and understand that any activities I undertake, online or in-person, at Yoga4U, located at 13 Bonavista Drive, Brampton L6X 0N2 ON – may require strenuous physical exertion that could cause injury. I understand that participating in the activities pose inherent risks. Injuries may include, but are not limited to, muscle tears, strains, and other musculoskeletal injuries, sprains, broken bones, cardiovascular complications, dehydration, dizziness, and fainting. I am fully aware of the risks involved and understand it is my responsibility to consult with a physician prior to participation. I hereby agree to assume full responsibility for any manner of loss, injury, COVID-19 infection, claim or damage, whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns. I expressly release and forever discharge Yoga4U and the Program Instructors; and waive any claim against them, their shareholders, officers, directors, successors, heirs or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation.

If you attend in-studio classes at Yoga4U, you agree to the following Liability Waiver:

I am fully vaccinated, and willing to provide government issued proof of vaccination for both doses.
I acknowledge the contagious nature of the Coronavirus/COVID-19 and public health authorities recommend practicing physical distancing.
I acknowledge that Yoga4U has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I acknowledge the government recommendations to take the Coronavirus/COVID-19.vaccine, as a way to protect ourselves and others from contracting Coronavirus/COVID-19.
I acknowledge that it is in my own interest, and sole responsibility, to take the Coronavirus/COVID-19 vaccine in order to protect myself and others from contracting Coronavirus/COVID-19.
I further acknowledge that Yoga4U can not guarantee that I will not become infected with the Coronavirus/Covid-19.
I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, studio staff, and other studio clients and their families.
I voluntarily seek services provided by Yoga4U and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending a class at Yoga4U.
I attest that:

I have received both Ontario government approved doses against Coronavirus/COVID-19.
I will provide government issued proof of vaccination upon request.
I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills,    repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
I have not traveled internationally within the last 14 days.
I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
I have not been diagnosed with Coronavirus/Covid-19.
I am following all WorkSafe ON recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Yoga4U harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the studio, or that may otherwise arise in any way in connection with any services received from Yoga4U. I understand that this release discharges Yoga4U from any liability or claim that I, my heirs, or any personal representatives may have against the studio with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Yoga4U. This liability waiver and release extends to the studio together with all owners, partners, and employees.

Studio Policy:

Payment must be made in advance.
***No refund, No transfer, No hold or extension***

The class sizes will be limited. You will need to register and book your class on Schedulicity to hold your spot ahead of time. As all classes are limited in size, please do not reserve a space you cannot attend. The cancelation policy is 3 hours prior to the class, so that other students on the waitlist may attend. If you sign up and do not attend, or cancel within the 3-hour window, you will still be charged for the class. 

**You MUST be fully vaccinated to attend in-studio classes at Yoga4U. If you are NOT fully vaccinated, you are not permitted in the studio. However, you may attend our online classes. This is to ensure everyones safety.**

As of September 22nd 2021, all students attending in-person classes MUST submit their government issued proof of vaccination to Yoga4U. All students are required to complete a COVID-19 self-assessment prior to each class to ensure safety. We will not allow teachers or students who have any of the COVID-19 related viral symptoms to enter the studio. If you are not feeling well, have recently traveled, or have been exposed to someone with COVID-19 or been in contact with someone who has traveled, you are required to stay home and are not permitted in the studio.

Masks are required while entering the studio, you will not be permitted inside without one. Masks can come off once you are set on your mat. Upon entering the studio, please sanitize your hands at our sanitization station, and promptly make your way to the mat. Be mindful of the entrance and potential risks. While entering the studio, wait for your turn, and maintain physical distance from other students. Please refrain from physical contact with each other– no handshaking or hugging. Please keep conversation minimal in the indoor space. Chatting is best outside and physically distanced.

We ask that you only bring what you need for class (mat/props/full water bottle/towel) and leave everything else at home or in your car. Blocks, belts, and other yoga equipment will be temporary unavailable for use. Please bring your own mat, and any other props you may need. Our bathroom will also be temporarily unavailable, please ensure you go prior to attending the class. Upon leaving the class, you must wear a mask and exit in an orderly fashion while maintaining physical distance. Please ensure you take all your gear home with you, including mat and props. Yoga4U will be sanitizing between classes, and need to ensure the studio remains clutter-free for your safety.

I have read the above policies, release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated herein in consideration for those services offered by Yoga4U/Gayatri Pathak.

I declare all of the information provided by me to be correct to my knowledge and have not withheld any information that may result in any consequences.

I agree to advise Gayatri Pathak at Yoga4U in writing if any of the information provided by me changes.

I hereby confirm that I have read and fully understand this release of liability and assumption of risk agreement, fully understand its terms, and sign it freely and voluntarily without inducement.

Signature & Date: *
Yoga4U - The Yoga & Reiki Studio
647-628-8241| | |
Front - 46 Baycliffe Cres, Unit-1, (Entrance on Ganton Heights)
Brampton, ON L7A 3Y7|
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