Adult Virtual/In-Person Waiver

Yoga, Pilates, Mindfulness, & Breathwork

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Address

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Emergency Contact Name:

Do you have any mental or physical health condition(s) requiring a doctor's permit to participate in meditation or sound healing activities?

Do you have a health condition(s) requiring a doctor's clearance to participate in ANY physical activities?

UPLOAD MEDICAL CLEARANCE IF NEEDED:

Please note any past and/or present injuries or medical conditions we should know about:

THIS SECTION IS FOR THE LADIES

Scroll to "The Last Section" if this does not apply

Do you have any issues or concerns with your pelvic floor?

Have you ever had a C-Section?

Are you currently pregnant?

If yes, how many weeks pregnant are you?

Do you have a high-risk pregnancy?

Do you have a high-risk pregnancy that requires a doctor's clearance for any of the services you are seeking?

UPLOAD MEDICAL CLEARANCE IF NEEDED:

Are you LESS THAN 12 months postpartum (after pregnancy)?

If yes, how many weeks or months postpartum are you?

Do you have Diastasis Recti (where the large abdominal muscles separate)?

Are you experiencing PPD (Postpartum Depression)?

Are you going through any of the following?

Check any issues that may apply:

ENDOMETROSIS

PCOS

IRREGULAR MENSTRUATION

Any other female health issues or concerns?

The Last Section

Any other health, or life challenges you would like to share:

Please feel free to share anything else about your concerns, relevant goals, or anything you feel will help us deliver a better service for you or your loved one:

I declare that the information I have provided is accurate and complete to the best of my knowledge, and that I agree to inform the instructor of any new injuries, conditions, or limitations before any class or stretch therapy session.

I agree to truthfully disclose my physical limitations, disabilities, ailments, or impairments, which may affect my ability to participate in this program. At this moment, I acknowledge this release from liability for accidental injury or illness I may incur due to participating in any physical activity.

I understand that yoga, yoga therapy, stretch therapy, meditation, breathwork, sound healing, pilates, and any other service or advice I receive is NOT a substitute for medical attention, examinations, diagnosis, or treatment.

I acknowledge that yoga, yoga therapy, pilates, stretch therapy, sound healing, meditation, and breathwork each carry inherent physical and emotional risks. I certify that I am physically and emotionally capable of participation, have disclosed any relevant medical or psychological conditions to the practitioner, and will immediately communicate any discomfort experienced during sessions.

I will respect my body and accept modifications suggested to me with a positive mindset for injuries, pregnancy, postpartum, or other reasons. I understand that modifications are offered to respect my body and ensure my safety, not to impose physical limitations or control my practice. It is my personal choice to make any advancements or modifications offered at any point.

I agree to turn on my video and audio if/when requested during virtual lessons and classes. This is not a demand, but I understand that if I don’t turn on my audio or video during sessions, the instructor will be unable to provide me with better personal feedback in virtual settings, as they cannot see my actions or hear my questions.

I will dress appropriately, wearing whatever attire I feel comfortable in, but nothing less than what is suitable for a hot yoga class (i.e., shorts and sports bra or tank top), applicable to both men and women.

✅ DO wear:

• Comfy clothes you can stretch in (leggings, shorts, sweatpants, T-shirts)

• Grip socks or yoga shoes if you need something on your feet

🚫 DON’T wear:

• Skirts or dresses (hard to move and keep covered, or safe in poses)

• Crocs, sandals, flip-flops

• Socks and shoes without grip (they can be slippery)

Why?

We want you to be safe, comfy, and able to move without slipping or tripping!

I will keep all conversations professional and appropriate, and speak to everyone in a kind and respectful manner

I understand that NONE of the activities I participate in will compromise my faith, religious beliefs, morals, or health, and that these are holistic wellness practices, with science-backed benefits for mind and body. None of your instructors are here to offer services as therapists, life coaches, medical doctors, or to provide religious or spiritual guidance, including metaphysics, witchcraft, or any other stereotypes and misconceptions about wellness practices.

I understand that no inappropriate touching will be given or accepted and that permission will be requested before any hands-on adjustments for in-person classes and private lessons.

I voluntarily assume all risks arising from participation and hereby release the practitioner(s), facility, and associated personnel from any liability for injury, loss, or damages that may occur.

I recognize that I have the FULL right to refrain from participating in any part of all sessions if something is uncomfortable for me. I, at this moment, assume all risks connected to this program and consent to participate in it.

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Participant Signature

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