Liability Waiver | ekalokayoga

Yoga Therapy Liability Waiver

First Name

Last Name

Date of Birth

Have you been hospitalized in the past 12 months and/or experiencing acute pain?

Yes

Please specify anything we should know about your physical and/or mental health and overall well-being.

Initials

I declare that the info I’ve provided is accurate & complete and that I am at least 18 years of age and a consenting adult.

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Select a date

Thanks for submitting!