Breath Body Soul Waiver Form
Please carefully read and agree to the terms of this waiver before participating in any classes. Your digital signature indicates your understanding and acceptance of the terms outlined below.  
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Name *
Email *
Address *
City, State, Zip *
Date of Birth *
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DD
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Home #
Mobile # *
Emergency Contact *
Emergency Contact # *
Are you currently exercising? *
If yes, how many times a week?
Do you play sports? *
Check all that apply *
Required
Photography/Video Release
Participants involved in any activities offered by Breath Body Soul, may be photographed or
videotaped during class.  The undersigned hereby consents to the use of these photographs
and/or videos without compensation on Breath Body Soul’s website or in any editorial,
promotional or advertising material produced and/or published by Breath Body Soul.

Please type your full name as your electronic signature.
*
Waiver and Release of Liability
Express Assumption of Risk: I, the undersigned, am aware that there are significant risks involved while participating in a yoga/Pilates/barre class. These risks include but are not limited
to falls, which can result in serious injury or death; injury or death due to negligence on the part of myself, my class partner, or other people around me; injury or death due to improper use or
failure of equipment; strains and sprains. I am aware that any of the above mentioned risks may result in serious injury or death to myself or my partner(s). I willingly assume full responsibility for the risks I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at or under the direction of Breath Body Soul.
I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.

Please type your full name as your electronic signature.
*
Release: In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Breath Body Soul. I, the undersigned, hereby release Breath Body Soul, their principals, agents, employees, and volunteers, from any and all liability, claims, demands, actions or rights of action which are
related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent act or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees.  If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.
Please type your full name as your electronic signature.
*
Indemnification: The participant recognizes that there is risk involved in the types of activities offered by Breath Body Soul, therefore the participant accepts financial responsibility for any
injury that the participant may cause either him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be
required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Breath Body Soul,
their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Breath Body Soul at the main building or abroad, including but not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for class by Breath Body Soul.

I have read and understood the foregoing assumption of risk and release of liability and I understand that by signing it obligates me to the parties named from any liability for the injury or death of any  person or damage to property caused, whether negligent or intentional. I understand that by signing this form I am waiving legal rights.
Please type your full name as your electronic signature.
*
Todays Date *
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