Yoga Heals Us LLC Registration and Waiver of Liability Form for Online Live Stream Yoga Classes and Video Recordings of Yoga Classes
The following named individual wishes to participate in Online Live Streaming Yoga Classes and / or Video Recordings of Yoga Classes provided by Karen E. Clarke and / or Yoga Heals Us LLC or Sandra Hartnett.
First and last name
Date of Birth
IF YOU ARE UNDER THE AGE OF 18, THIS AGREEMENT MUST BE COMPLETED BY YOUR PARENT OR LEGAL GUARDIAN. PLEASE CONTACT
for the applicable form.
# Street, Apt., City, State, Zip Code
I'm interested in (select all that apply):
The class (es) I'm interested in are (select all that apply):
Live-Stream All Levels
Live-Stream Gentle Adaptive
Live-Stream Chair Yoga
Live-Stream Meditation / Yoga Nidra
Recorded Class All Levels
Recorded Class Gentle Adaptive
Recorded Class Chair Yoga
Recorded Class Meditation / Yoga Nidra
Chair Yoga Training (must meet the pre-requisites)
This section is for those who are enrolled in a TIYT (Trauma Informed Yoga Therapy) program with or have that intention.
I am enrolled in TIYT or have that intention.
Does not apply to me
Release of Liability
Acknowledgement; Release of Liability & Waiver
I RECOGNIZE THAT THESE ACTIVITIES, Online Live Stream Yoga Classes and Video Recordings of Yoga Classes, AND OTHER ACTIVITIES OF THIS NATURE INVOLVE AN ELEMENT OF PHYSICAL, EMOTIONAL, AND PSYCHOLOGICAL RISK, INCLUDING SERIOUS INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE. I UNDERSTAND EACH PERSON’S LEVEL OF PHYSICAL AND PSYCHOLOGICAL FITNESS IS DIFFERENT, AND THAT SOME ACTIVITIES MAY NOT BE APPROPRIATE FOR ME GIVEN MY INDIVIDUAL CAPACITIES. I ACCEPT THE NEED TO MONITOR MY OWN PARTICIPATION, KNOWING THAT EACH ACTIVITY,
AND EACH EXERCISE WITHIN ANY GIVEN ACTIVITY, IS OPTIONAL. IT IS FINE FOR ME TO SIT OUT AN ACTIVITY OR EXERCISE.
I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DEATH, OR PROPERTY DAMAGE, WHETHER CAUSED BY THE NEGLIGENCE OF Karen E. Clarke and / or Yoga Heals Us LLC or OTHERWISE.
After being informed of the above risks and responsibilities, I hereby expressly waive and release any and all claims, now known or hereafter known in any jurisdiction throughout the world, against Karen E. Clarke and / or Yoga Heals Us LLC and its officers, directors, employees, agents, affiliates, successors, and assigns (collectively, “Releasees”), arising out of or attributable to my participation in the Activities, whether arising out of the negligence of Karen E. Clarke and / or Yoga Heals Us LLC or any Releasees or otherwise. I covenant not to make or bring any such claim against Karen E. Clarke and / or Yoga Heals Us LLC or any other Releasee, and forever release and discharge Karen E. Clarke and / or Yoga Heals Us LLC and all other Releasees from liability under such claims.
BY COMPLETING AND SUBMITTING THIS FORM, I acknowledge that I have read and understood all of the terms of this Registration and Release of Liability Agreement and that I am voluntarily giving up substantial legal rights, including the right to sue Karen E. Clarke and / or Yoga Heals Us LLC or Sandra Hartnett under certain circumstances.
A copy of your responses will be emailed to the address you provided.
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