RELEASE OF LIABILITY WAIVER FORM FOR PRIVATE CLIENTS

Below is the consent/waiver form that will need to be filled out and signed by every student of Lauren Young.  Copies will be provided prior to class and will need to be completed prior to your child's lesson. 

RELEASE OF LIABILITY WAIVER FORM

I, _______________________________, being over the age of eighteen and parent or legal

guardian of __________________________ in consideration of the services to be provided by

Lauren Young, do hereby release and discharge said Lauren Young its officers, owners, and

employees as follows:

·         I understand that yoga is an activity that involves physical movements and opportunities for relaxation, stress reduction, and relieve of muscular tension.

• As in the case with any physical activity, the risk of physical injury, whether minor or serious and disabling, cannot be entirely eliminated.  I know of no physical or mental condition that would prevent my child from participating in yoga activities, exercises, or instruction. I will inform the instructor of any health or behavior conditions that may prevent my child from safe participation in yoga.

• Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions.  I understand that I alone am responsible for keeping the instructor informed of my child’s health needs and deciding if he/she should practice yoga.

• I have fully read this Release of Liability Waiver Form carefully.  I voluntarily give up certain legal rights and possible claims, demands, and rights of action which are or may be related to or arise out of my child’s participation in yoga instruction, and release Lauren Young, its officers, owners, and employees from any omissions, acts or negligence of any sort.

• I  DO/ DO NOT (please circle one) give permission to use photographs or video of myself or my child for promotional purposes.  I understand that my child will not be identified by name, nor will any compensation be extended for such use.

By signing this Release of Liability Waiver Form, I acknowledge that I fully understand and voluntarily accept its statements.

Child’s Full Name: ___________________________________  Date of Birth: ______________

Parent(s)/Guardian(s) Full Name(s):_________________________________________________

Address: ______________________________________________________________________

City:____________________________________ State: _______  Zip Code:________________

Cell #1:_________________________________  Cell #2:_______________________________

Home #:________________________________  E-Mail:_______________________________

Emergency Contact and Number:___________________________________________________

Doctor Name and Number:________________________________________________________

Please list all known allergies, physical limitations, concerns, and goals:

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