URW Activity Disclaimer and Waiver
I hereby consent as a participant in Uprooted Replanted Wellness classes and events and agree to assume all of the risks involved. I understand the Uprooted Replanted Wellness does not provide medical insurance relative to accidents, injuries, and or/death as a result of program related activities; and that I can not hold Uprooted Replanted Wellness or affiliated Uprooted Replanted Wellness instructors personally responsible for any liability.

I recognize that any form of physical activity is a potentially hazardous one, and that they involve a risk of possible injury or even death. I hereby affirm that I am voluntarily participating in these activities with the knowledge of the risk involved. I agree to expressly assume and accept any and all risks of injury and/or death.

I hereby affirm myself to be physically sound and suffering from no condition, ailment, impairment, disease, or other illness that would prevent my participation in Uprooted Replanted Wellness activities. I declare that I have disclosed any and all medical history to Uprooted Replanted Wellness and or/ their affiliates relevant to participation.

I agree to release my image in the form of photos or videography for the promotional use of Uprooted Replanted Wellness.

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New Student Information
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