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Private Yoga Intake and Consent Form

Birthday
Month
Day
Year

1.    I agree that I am participating in a Private Yoga Session offered by Shelly Werts RYT, during which I will receive information and instruction about yoga and health. I recognize that yoga may require some physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2.    I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the yoga session. I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the yoga session.

3.    In consideration of being permitted to participate in the yoga session, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

4.    In further consideration of being permitted to participate in the yoga session, I knowingly, voluntarily and expressly waive any claim I may have against Lotus Counseling and Wellness Center LLC., or its owner Shelly Werts, for any injury or damages that I may sustain as a result of participating in the program.

  1. I, my heirs or legal representatives, forever release, waive, discharge and covenant negligence or other acts.

 

I have read the above release and waiver of liability and fully understand it. I voluntarily agree to the terms and conditions stated above.

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