Cool Creek Farm Yoga 
Please register below for 75-minute, outdoor, all-levels, flow yoga classes at Cool Creek Farm, 738 Castle Rock Farm Road, Pittsboro, on Sundays at 9am with Katie Cousins. Class will proceed in all temps 40 and above.  Rain cancellations will be made at least an hour before class via text. 
Please bring your own blanket/towel/mat and/or props.
Sign in to Google to save your progress. Learn more
Email *
Your Full Name *
Cell Phone Number (for texting day of weather cancellations) *
Emergency Contact, Name and Number *
Select your days  *
Liability Waiver & Informed Consent Agreement

Acknowledgment of Risk

I understand that yoga, movement, breathwork, and related practices offered by Fireforged Yoga may involve physical exertion and carry inherent risks, including but not limited to:
● Muscle strains, sprains, or tears
● Falls or loss of balance
● Aggravation of pre-existing injuries or conditions
● Dizziness, shortness of breath, or changes in blood pressure
I acknowledge that I am voluntarily participating in these activities with knowledge of these risks.
Health & Personal Responsibility
I affirm that:
● I am in sufficient physical condition to participate in yoga and movement practices
● I have consulted a healthcare provider if I have any medical concerns or conditions
● I will listen to my body and modify, pause, or stop as needed
● I will inform the instructor of any injuries, limitations, or concerns before class
I understand that I am solely responsible for my own well-being during and after each session.

Assumption of Risk

I knowingly and voluntarily assume full responsibility for any risks, injuries, or damages that may occur as a result of my participation in any Fireforged Yoga class, event, or session, whether in-person or virtual, and regardless of location.

Release of Liability

In consideration of being allowed to participate, I hereby release, waive, and discharge Katie
Cousins, Fireforged Yoga, Cool Creek Farm and Melissa Frey from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by me while participating in any yoga class, workshop, or related activity at Cool Creek Farm.

Third-Party Locations

I understand that Fireforged Yoga classes may be held at various locations not owned or
controlled by the instructor. I agree that:
● These locations are used “as is”
● The instructor is not responsible for the condition of the property
● I assume any risks associated with the environment, including uneven surfaces, weather, or other site-specific conditions

I have read this waiver in full, understand its contents, and voluntarily agree to its terms. I
understand that I am waiving certain legal rights, including the right to sue by entering my full name below. 
*
I understand that I am registering for outdoor yoga with certified-instructor Katie Cousins.  Each class is $18.  You can bring exact cash or a check to class or Venmo (www.venmo.com/Melissa-Frey-32).  Credit will be given for class missed due to inclement weather or instructor cancellation or notification of your absence at least 2 hours before the start of class.  Class will proceed in non-rain temps of 40 degrees and above.  Cancellations due to weather will be made at least 1 hour prior to the start of class and you will be notified via text message. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report