Consent Waiver
I, Bobbie-Raechelle Ross am a Registered Yoga Teacher, and currently enrolled in the Ajna
Yoga College’s 800-hour Yoga Therapy Program. Upon graduation, I will be eligible for status
designated as a Certified Yoga Therapist with the International Association of Yoga Therapists
(C-IAYT). As part of this program I am required to teach 63 hours of group Therapeutic Yoga Sessions and 50 private Therapeutic Yoga Sessions.

A member from Ajna Yoga’s faculty will supervise these sessions.
I seek your support and commitment to help me with this journey by participating as a
student/client. I will make the following ethical commitment to you:

● Acknowledge the limitations of my skills and scope of practice and where appropriate, refer
students to seek alternative instruction, advice, treatment or direction.
● Create and maintain a safe, clean and comfortable environment for the practice of yoga.
● Encourage diversity by respecting all students regardless of age, physical limitations, race,
creed, gender, ethnicity, religion or sexual orientation.
● Respect the rights, dignity and privacy of all students.
● Keep any information you share in person or in writing confidential and secure.
● Adhere to the traditional yoga principles as written in the yamas and niyamas.
● Conduct myself in a professional and conscientious manner. This includes, but is not limited
to, ensuring that I live up to any commitments I make to my students or to the public, and
ensuring that my practices and behavior conform to the representations I make about myself in
holding myself out as a yoga practitioner who adheres to certain precepts.

Please feel comfortable to ask me any questions about my training. I also appreciate any
feedback about my teaching you may be willing to share with me so that my learning can
continue.
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Acknowledgement and Waiver
I acknowledge that Bobbie-Raechelle Ross, who I will be working with, has informed me that Yoga with a therapeutic approach is not a medical procedure; and that they will not be providing a diagnosis of any medical problems or concerns which I have. I understand that Yoga with a Therapeutic approach is an integrative practice intended to facilitate self-awareness, integration and balance to my well-being. I also understand that I am solely responsible for my health, safety and well-being. I agree to inform the yoga instructor of any activity or movement which I cannot perform safely, and that I will not perform any activity or movement, which I feel, is likely to cause me to injure myself. I agree to hold Bobbie-Raechelle Ross harmless from any and all responsibility for any injury, which I may sustain during or as a result of my Yoga therapy informed sessions. *
Required
If agreeing to the above statement, please type your name in the space below accompanied by the date to validate your response. By typing your name in the space below you are signing in agreement to the above waiver releasing any liability from the mentioned Yoga Therapist. *
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