CIRCLE ON THE SQUARE HEALTH INFORMATION
Please share any information that you feel might interfere with Circle on the Square physical practice and keep your instructor informed of any changes.
To the best of your knowledge, do you currently or have you ever had any of the following conditions?
(Please check all that apply) *Must have physicians release
High blood pressure*
Low Back Pain
Bone or Joint Problems
Allergies: (please list)
Has your doctor ever informed you that you have heart trouble?
Have you undergone surgery (minor or major) within the past two years?
If yes, please describe
Do you have any (other) medical conditions, which limit your ability to exercise?
AGREEMENT OF RELEASE & WAIVER OF LIABILITY
1. That I am participating in the physical activity classes or workshops offered by CIRCLE ON THE SQUARE during which I will receive information and instruction about yoga and/or fitness. I recognize that yoga and/or exercise requires physical exertion which may be strenuous and may cause injury, and I am fully aware of the risks and hazards involved.
2. I understand that it is my responsibility to consult with a physician (prior to and regarding my participation in the offered classes or workshops) about any medical conditions I may have.
3. In consideration of being permitted to participate in the classes or workshops, I agree to assume full responsibility for injuries or damages, known or unknown, which may incur as a result of participating in the program. I knowingly, voluntarily and expressly waive any claim I may have against CIRCLE ON THE SQUARE for any damages that I may sustain as a result of participating in
4. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue CIRCLE ON THE SQUARE, Candace Fruge or instructors for injury or death caused by their negligence or other acts.
I have read the above release and waiver of liability and fully understand its contents.
I voluntarily agree to these terms and conditions.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service