Waiver / Intake Form

1. I am participating in yoga classes, health programs, workshops and other exercise and healing arts activities (collectively, the "activities") offered by Lotus Counseling and Wellness Center LLC ("center") and/or its owners, instructors, teachers, workshop presenters, employees and independent contractors ("staff").

2. I recognize that I must be in good physical and mental health to participate in the activities and understand that I am responsible for my limitations and/or medical concerns that may limit my abilities. I understand that is it my responsibility to consult with a physician with these limitations prior to attending activities. I understand that the center reserves the right in its absolute discretion to refuse participation in any activity on medical or fitness grounds.

3. I am aware that participation could in some circumstances result in abnormal blood pressure, fainting, physical injury, or exacerbation of any medical conditions., and it is my responsibility to let the staff know.

4. In consideration of being permitted to participate in activities, I agree to assume full responsibility for any risks, injuries, or damages known or unknown, which I might incur as a result of entering or being on the premises/property/or activities participated with the center in or out of the facility.

5. I knowingly, voluntarily and expressively waive any claims legal or otherwise I may have against the center/premises, its owners, members, employees, contractors, instructors, teachers, volunteers, interns, or landlord. I agree to indemnify and hold harmless each released party from any loss or liability uncured in defending any claim made by me or anyone making a claim on my behalf, even if the claim is alleged to or did result from the carelessness or negligence of any released party or anyone else. Claims included but are not limited to any and all liabilities, claims, demands, expenses, fees, legal actions, rights of actions for damages, personal injury, mental suffering and distress, or death that I may suffer, my family may suffer in connection with the center and its activities.

6. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any released party for any claim caused by any negligence or other acts of a released party.

7. I understand that it is my continuing responsibility to inform staff at the center of all medical conditions, injuries, or surgeries, prior to attending activities and at such other times as I acquire information as to same.

8. I understand that I have no claims against the center by reason of their refusal to allow me to participate in any activities.

9. All tuition and registration fees are non-refundable, non-transferrable, and cannot be extended, unless deemed appropriate by the owner.

10. I also agree that the center is in no way responsible for the safekeeping of my personal belongings while I attend activities or if left behind.

11. This agreement shall be construed in accordance with, and governed by, the laws of the State of Kentucky.

12. I acknowledge that I have carefully read this release and waiver of liability and fully understand its contents. I voluntarily and knowingly agree to the terms and conditions stated herein.

By signing this document, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.