The Yoga Bungalow Consent - Youth
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Name *
Date Of Birth *
MM
/
DD
/
YYYY
Address *
City *
Email *
Hobbies/Interests? *
Name Of Parent/Guardian *
Parent/Guardians Phone Number *
Parent/Guardians Email *
Emergency Contact Name *
Emergency Contact Number *
Has Your Child Practiced Yoga Before *
If your child is currently experiencing any medical conditions (e.g injury, asthma, epilepsy...) Please Specify *
Does Your Child Have Any Pain In The Following *
Required
Liability Release - Child Waiver (to be completed by the Parent or Guardian)
If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest
at any time during the class. It is important in yoga that you listen to your body, and respect its limits on
any given day.
I, the undersigned, understand that yoga is not a substitute for medical attention, examination, diagnosis, or
treatment. I should consult a physician prior to beginning any activity program, including yoga.
I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will
not perform any postures to the extent of strain or pain.
I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or
property, resulting from the taking of the class.
Please note that from time to time I use pure essential oils in my yoga classes, if you child is allergic to essential oils - please let me know prior to class commencing.
I accept that there are cameras for personal and property security.

I Agree To The Above Terms *
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