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Do you have any special reasons for doing Yoga?

E.g. Mental health, Wellbeing, Back issues, etc.

Are there any other health issues or injuries that you need or wish to tell us about?

Are you currently taking any medication?

WOMEN ONLY

Any symptoms?

PLEASE READ THIS:

Your teacher will take all possible care to ensure your well-being, enjoyment and safety in your class. However, it is your body and you know its strengths and limitations best. It must be your responsibility to not exceed your current abilities and to inform your teacher. If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day. I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation. I understand that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program if required. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician’s approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Hills Yoga School and all related facilities and premises for any personal injury or negligence. Additionally, the facility, instructor and Hills Yoga School are not in any way responsible for any loss or damage of your personal property. Those under 18 years of age must have this form signed by a parent or guardian. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. I have carefully read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as the complete and unconditional release of all liability to the greatest extent allowed by law and that it cannot be changed orally.

I acknowledge the above

Please sign your full name & today's date

Signature of parent/guardian if under 18

Please sign full name & today's date

Hills Yoga School Medical Form