Change Yoga Health Waiver
Please complete our Health Waiver Form and bring it with you to your first class.
Email address *
Please notify the teacher of any injuries or illness prior to your first class.
Name *
Your answer
Date of birth *
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Address *
Your answer
Suburb
Your answer
Postcode *
Your answer
Mobile number *
Your answer
Occupation *
Your answer
Would you like to learn about special offers/discounts and upcoming events via email? *
Have you had, or do you have any of the following?
Yes
No
Have you regularly practiced yoga in the past?
Are you a male over 35 or female over 45 and not used to regular exercise?
Recent hospitalisation and/or surgery
Any heart conditions
Are you pregnant?
High blood pressure (>149/50) (if yes, please check with your doctor before commencing this exercise program)
Gout, Stroke, Diabetes, Epilepsy, Hernia, Glandular Fever, Rheumatic Fever
Dizziness or Fainting
Arthritis, Asthma, Cramps, Muscular pain
Any pain/injuries to the neck, back, knees, ankles
Other conditions that would cause you to modify your exercise program (please specify)
Your answer
How did you hear about us? *
Required
Terms & Conditions
I confirm and agree that the following terms, conditions and undertakings apply to the Change Yoga exercise and training classes to be provided to me by Change Yoga & Wellness.

I have been examined by a licensed medical practitioner (“Practitioner”) within the past six months and have been found by the Practitioner able to perform all vigorous stretching and the Change Yoga & Wellness exercises, which I am to perform during my enrolment with Change Yoga & Wellness. I will faithfully follow all instructions given to me by Change Yoga & Wellness and its teachers as to when, where and how to perform the instructed exercises. I agree and acknowledge that participation in any Change Yoga & Wellness classes could constitute a risk of serious injury to me, including permanent paralysis or death. I voluntary and knowingly recognise, accept and assume this risk and warrant that I am physically fit and able to perform the exercises provided. I acknowledge that neither Change Yoga & Wellness, its owners, teachers or employees shall be nor be deemed to be responsible or liable (whether in contract, or in tort or under any statute whatsoever), for any injury, illness or mishap I sustain arising from or out of, or in any way directly or indirectly connected with the Change Yoga & Wellness classes.

I understand and acknowledge that I am to receive instruction in Change Yoga & Wellness Classes and theory only. Change Yoga & Wellness, its owners, teachers, or employees are not liable for, nor expected to provide any advice, training or medical assistance other than in the form of the classes provided. I indemnify and will at all-time hereafter well and
sufficiently indemnify and keep fully indemnified Change Yoga & Wellness, its owners, teachers or employees from and against all actions, suits, causes of action, proceedings, claims, costs and expenses whatsoever which may be taken or made against Change Yoga & Wellness, its owners, teachers or employees or incurred or become payable by Change Yoga & Wellness, its owners, teachers or employees of in connection with or arising out of any such injury, illness or mishap to me.

The fees paid by me under this enrolment to Change Yoga & Wellness are non-refundable. Change Yoga & Wellness may in its sole discretion grant refunds to me without prejudicing any of its rights.
Signed *
Please type your full name below
Your answer
Today's date *
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