Yin Yoga /Reiki Healing Waiver & Registration
Before receiving services from UnbrokenCircles, all participants must agree to the following Waiver and Release Agreement. Please complete the form to submit your electronic signature.

This Form is your digital waiver and opt-in to the email list for future classes. If you'd like to opt out of the email list, you may do so at any time :)

At any time, I will be offering links to recorded classes for Essential Workers , Helpers, and Healers to help us round out the remaining month of this year. These classes are offered at no-cost to helpers, friends, and family. If you would like to offer $ for my time, you are welcome to make a purchase through my website (https://unbrokencircles.com/shop) or a contribution via Venmo @unbrokencircles . Purchase or donation not required for participation in these classes. The only thing I require for your participation is your email and your completion of the waiver below.

Starting December 2020, I will be offering 2 classes a month corresponding with the first and final quarter moons focused on taking action toward goals, dreams, and visions and then later on reflecting, releasing, and recalibrating. These classes will be offered as pay-what-you can with the valued rate at $11. Please register in advance to receive the class link and know that you will also receive a recording link upon registration. if you'd like to sign up for recurring monthly classes with me which will be offered 2x a month in accordance with the 1st and 3rd Quarter Moons, please check out my patreon https://www.patreon.com/unbrokencircles

My local studio where I teach monthly pop-up Yin Yoga & Journaling courses is Woodlawn Yoga and they appreciate any and all support and shares https://woodlawnyoga.com/. These classes are not free, and they offer online recorded classes by donation and for purchase.

Woodlawn offers a $20 for 2 weeks of unlimited yoga to new students, so for $5 more, you can take as many classes as you'd like online with them for the next 2 weeks or from the first day you sign up. This studio has been really special and a life saver to me as I've used Yoga as my main self-care, grounding, sanity practice over the last 5 years.
How did you find UnbrokenCircles *
What is your name? *
What is your email? (where you will be sent a link for class/a session) *
Which time(s) would you like to register for? (check all that apply) *
Are you in the PST Time Zone? I will be teaching from the PST Time Zone, but thanks to the internet, you can join from any time zone.
Clear selection
Is there anything you want me to know about you in relation to your participation in Services? Please describe anything I should know below. Know that by signing up to participate in these classes, you are also completing a liability waiver and I can offer modifications and suggestions, but am not a medical provider. You should always consult with a medical provider who knows your medical history for those types of questions. I am here to guide and offer space to help you help yourself, your nervous system, and find rest.
As the student taking classes or workshops with UnbrokenCircles, I understand that UnbrokenCircles classes include physical movements and exertion. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in UnbrokenCircles classes, whether in-person or online. I represent and warrant that I am in good health and physical condition and I have no medical condition which would prevent my full participation in UnbkorenCirlces classes, whether in-person or online. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature below verifies that I have my physician’s approval to participate. In consideration of being permitted to participate in UnbkorenCirlces classes, whether in-person or online, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program. In further consideration of being permitted to participate in UnbrokenCircles classes, whether in-person or online, I expressly irrevocably release and waive any claims that I have now or may have hereafter for any reason against UnbrokenCircles, its owners, employees and independent contractors, for injury or damages that I may sustain as a result of participating in a class, whether in-person or online *
THANK YOU for your work. Having worked in social work by varying titles for a decade, I know that you don't often hear this. The goal of offering this is to offer a space for you to take an hour-ish of your time for YOU. You give throughout your days to others and you and your nervous system deserve an hour to rest, relax, pause, and heal. I have a few classes/meditations uploaded to YouTube and am new to venturing into moonlighting as a yoga teacher and meditation guide. I appreciate you coming along this journey with me and want you to remember that YOU have the ability to make it through this AND you are only human.
Take care, rest, relax, and know that I have no expectations that you will participate beyond clicking into my classes (camera on or off), but I will stick around 10 minutes before and 15 minutes after class for anyone needing / wanting more connection. For additional things you can do on your own time : https://www.youtube.com/channel/UCE_ZiA_yQQWG-L9vxE53-gQ/
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy