Here and Now Yoga ~ New Student Info / Waiver
Name: *
Address: *
Cell Phone: *
DOB: *
MM
/
DD
/
YYYY
Occupation: *
Emergency contact ~ Name / Relationship / Phone: *
Yoga / Sports experience (even from youth):
Physical health issues / concerns / recent injuries:
Goals (Yoga and / or Life):
Referred by:
Agreement of Release / Waiver of Liability / Cancellation Policy: I (the undersigned) understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated and I assume full responsibility. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Under certain medical conditions, yoga is not recommended and is not safe. I affirm that I alone am responsible to decide whether to practice yoga. I understand that it is my responsibility to consult a physician prior to and regarding my participation in the yoga class or workshop. Re: in-person sessions: I understand at the time for which this class is scheduled, the COVID-19 infection rate in NYC and on Long Island, NY is around 1%. However, I understand and assume responsibility for voluntarily attending an in-person private or group class that may still put me at slightly more risk of exposure to COVID-19. I agree to wear my mask to my yoga mat and any time I am moving about the property. I agree to follow all stated rules (NYS) for physical distancing measures to maintain my own health and the health of others. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Michelle Cavanagh/Here and Now Yoga and or instructors hired by Michelle Cavanagh/Here and Now Yoga. Cancellation Policy: Wherever possible, please give minimum 24 hours cancellation/rescheduling notice for sessions. Of course, emergencies and unexpected situations arise, but please try to avoid last minute cancellations as your time slot can be offered to another student. If cancellation policy is not respected, your session fee may be forfeited for that day. I have read the above release, waiver of liability and cancellation policy, and fully understand their contents. I voluntarily agree to the terms and conditions stated above. *
By typing your name on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Hereandnowyoga.com. Report Abuse