Event Name or Yoga Class
Name
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First and Nickname if other
First Name
Last Name
Birthdate
Emergency Contact Info
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My Address
Home Phone
Cell Phone
Work Phone
Email
Occupation
How did you hear about this studio or class or event?
Please describe your yoga or past experience with exercise: How many classes, how long,with whom, home practice, etc.
Check any and all conditions which apply
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For each item checked above please briefly describe
Liability, Release, Acknowledgement and Waiver: I understand and acknowledge that in yoga, as in other forms of physical exercise, bodywork or self-development, there are inherent risks, including the risk of injury. I agree that I am voluntarily participating in the programs and related activities offered by Linda Mills, Studio Mills and all of its instructors, and I assume all risks of injury, illness or death. Because yoga, physical exercise, bodywork and some self-improvement techniques can be strenuous and subject to risk of serious injury, I understand that I should consult with my doctor before participating in any exercise activity, including those offered by Linda Mills and all classes at Studio Mills or at the above named location and event. I acknowledge that I have carefully read this, “Liability, Release, Acknowledgement and Waiver” and fully understand that it is a release of all liabilities of any type or kind. I expressly release and fully discharge Linda Mills and all of its affiliates, employees, agents, instructors, representatives, successor and assigns, from any and all claims or causes of action of any kind or nature that I may now or hereafter have against any or all of them, and I agree that I have voluntarily given up and waived any right that I may otherwise have to bring legal action of any kind against Linda Mills, properties for events or any of its affiliates, employees, agents, instructors, representatives, successors or assigns, for personal injury or property damage. This Liability, Release, Acknowledgement and Waiver of liability includes, without limitation, all injuries of any type, kind or nature that may occur, directly or indirectly, as a result of my instruction, training, supervision, or dietary recommendations by Linda Mills, the agents, instructors, representatives, successors, or assigns, my slipping and or falling with participating any activity on the premises, including adjacent sidewalks and parking areas. In addition, Linda Mills is not responsible for any loss of, or damage to my personal property. If any portion of this release from liability shall be deemed by a Court or competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in fullforce and effect and the offending provision or provisions severed here from. By signing this release, I acknowledge that I understand its content and this release cannot be modified orally. E-Signature and Date in block below.
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