Dragonfly Yoga Activity Waiver Form
Email address *
Activity Waiver / Health Form
1. The practice of yoga, like any physical activity or sport, involves the inherent risk of injury. For that reason, all participants are required to submit this waiver, releasing the instructor and Dragonfly Yoga of any and all responsibility of injury to the participant.

2. All participants must answer the following questionnaire indicating medical conditions or concerns prior to engaging in the activity. If you are unsure about your physical ability to take part in yoga class because of a physical condition, consult your physician before enrolling, and please speak to the instructor before engaging in the practice.

3. I hereby acknowledges that I understands the implications of submitting this waiver and willingly accepts responsibility for any strains or injuries that could occur during or as a result of participation in a Dragonfly Yoga class.

4. I am aware that my participation in this activity can result in injuries or health issues which may include but are not limited to bones, joints, ligaments, muscles, tendons, spine and other aspects of the skeletal system, as well as internal organs, vertigo, and general health and well being. I understand these risks and realize that I am responsible for any and all injuries that may occur during or as a result of engaging in this activity. I will not hold the instructor or Dragonfly Yoga liable in any way should I incur an injury or impairment as a result of practicing yoga.

Full name *
Your answer
Phone number *
Your answer
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
EXPERIENCE with Yoga *
Have you had a physical in the last year? *
Do you ever feel faint when your head is in a position below your heart? If so, describe: *
Your answer
List any injuries, past or present, which you feel the instructor should be aware of: *
Your answer
Please list any other concerns you have about practicing yoga: *
Your answer
What are you goals for enrolling in a yoga class / session?
Your answer
By clicking "Submit" you agree to all terms and conditions of this waiver.
A copy of your responses will be emailed to the address you provided.
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