FamilyFlow Yoga® Waiver
Please complete the form below before your upcoming class. Questions? Email adrienne@familyflowyoga.com
Email address *
Full Name: *
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Child's Full Name: *
Your answer
Address: *
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M/F: *
Age: *
Please enter the product number
Your answer
Child's Age: *
Please enter the product number
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Emergency Contact Name *
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Emergency Contact Phone Number *
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If you are currently experiencing any medical conditions (e.g. injury, asthma, epilepsy...) that the instructor should be informed of please specify here: *
Your answer
If you are currently taking medications or has serious allergies that should be made known to medical personnel in case of an emergency, please indicate them here:
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Asana (yoga posture) means posture easily held. If it’s too hard or if it hurts, you can stop! You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day. I understand that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. In the case where myself/child has an injury, sickness or anything else that may be affected by physical activity, I have consulted with physician to ensure myself/child can take yoga classes. I recognize that is is my responsibility to notify the instructor of any serious illness or injury before every yoga class. In further consideration of permitting myself/child to participate in yoga class, I knowingly, voluntarily and expressly waive any claim I may have against Adrienne Smith, FamilyFlow Yoga® and the owner/lessor of the Premises for injury or damages that my child may sustain while on the Premises as a result of participating in the yoga class. I, my heirs or legal representatives irrevocably covenant not to sue and forever release, waive, and discharge any other claims of any kind whatsoever against Adrienne Smith, FamilyFlow Yoga®, OR the owner/lessor of the Premises for any personal injury, property loss or damage, or wrongful death, whether caused by negligence or otherwise. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. I accept that neither the instructor, nor the hosting facility is liable for any injury, or any damages, to person or property, resulting from the taking of the class. Please note, FamilyFlow Yoga® may occasionally use aromatherapy and pure essential oils in class. If you are allergic to essential oils, advise before each class. *
I hereby grant Adrienne Smith and FamilyFlow Yoga® permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. *
Signature of Student/Guardian: *
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Date: *
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