Health & Liability Waiver
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Please check any of the following conditions that apply to you.
If you feel that any of these would limit your participation in class, please describe further below.
Glaucoma or Detached Retina
Eye, Ear, or Sinus Infection
High Blood Pressure
Low Blood Pressure
Neck Problems or Injury
Shoulder Problems or Injury
Elbow Problems or Injury
Wrist/Hand Problems or Injury
Back Problems or Injury
Sciatica/Sciatic Nerve Issues
Sacro-Iliac (SI) Joint Pain
Knee Problem or Injury
Ankle/Foot Problem or Injury
Recent Acute Injury
Please use this space for any other condition not listed above that you believe might limit your ability to participate in class or comment on any of the above conditions.
Please read each statement carefully and check the boxes to indicate your agreement and understanding:
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction, and muscular tension relief. As in the case of most physical activity, the risk of injury (including serious and/or disabling injury and possibly death) is always present and cannot be entirely eliminated. While at the studio, I agree to honor and respect my body's capacity for movement as well as those I practice with.
Awareness is fundamental to the practice of yoga. It is fully my responsibility as a student to monitor each activity and determine whether it is appropriate for me to participate. If any pain or discomfort is experienced, I will listen to my body, make appropriate adjustments, and ask for assistance if necessary. By choosing to participate, I voluntarily assume responsibility for any injury.
I understand that is it my responsibility to consult a physician prior to and regarding my participation in a yoga class. I recognize that is it my responsibility to notify the teacher of any recent illness, injury, or surgery before every yoga class. I understand that certain yoga poses and/or breathing exercises are contraindicated for particular medical conditions (e.g., cardiac illness, post-surgery, later stages of pregnancy), and that yoga is not a substitute for medical attention, examination, diagnosis, or treatment.
I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now, or hereafter may have, against Sync Mind/Body/Fitness, LLC - DBA: just breathe mindful movement studio, their teachers, and/or its studio space leased from Zamias Property Management. I agree that just breathe mindful movement studio, its teachers, and/or its studio space shall not be liable for any claim, demand, or cause of action of any kind whatsoever for, or on account of personal injury, property damage, or property loss of any kind resulting from or related to my use of the facilities or participation in any group activity or personal session.
I affirm that I have read and understand the above statements and voluntarily agree to the terms and conditions stated above.
Please type your name here to serve as a digital signature:
Thank you so much! We look forward to seeing you at the studio soon!