Yoga Class Waiver Form

Please fill out and submit this waiver prior to joining a class or retreat. All information is kept confidential.

First Name

Last Name

Email

Phone

Address

Birthday

Emergency Contact Name

Emergency Contact Phone Number

Have you practised yoga before?

No

Yes

Do you have any medical conditions or injuries?

No

Yes

Please check any existing conditions:

High blood pressure

Back/neck pain

Knee pain

Low blood pressure

Hip pain

Anxiety

Depression

Glaucoma

Pregancy (please include how far along you are)

Low blood sugar

I will practise mindfully and if at any time during the class, I feel discomfort or strain, I will gently come out of the posture. I know that I can rest at any time during the class. I will listen to my body, and respect its limits on any given day.

I understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will not perform any postures to the extent of strain or pain.

I accept that neither the instructor, Evanachan Farm, nor West Coast Wellness, is liable for any injury, or damages, to person or property, resulting from the taking of the class and/or participating in this day retreat.

Date

Your Signature

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