RELEASE AND WAIVER OF LIABILITY
Name:___{name}______________________________
Date of Birth: ____{dob} _______________________
Address:___________{address} ___________________________________________________________
Phone: ______{phone}________________
Name/Phone of Emergency Contact: ____________{contact_name}___________{contact_phone}________________________
It is your responsibility to inform the instructor of all of your limitations as to exercise before class begins.
I represent and warrant that I am in good physical health and do not suffer from any medical
condition which would limit my participation in the classes offered at _Yoga With Kileen_. I understand that it is my responsibility to consult with a physician prior to taking any classes or instruction regarding my participation in any of the yoga exercises or activities. I understand the risks associated with the activities offered by _Yoga With Kileen_ and I agree to follow all instructions that are given to me regarding all aspects of these yoga activities, including but not limited to I how I can safely participate.
I hereby RELEASE _ Yoga With Kileen_ and WAIVE any and all claims, demands, causes of action of any kind, against _Yoga With Kileen_. It’s owners, officers, employees, and instructors resulting from or related to my participation in the activities and programs offered at the _Yoga with Kileen_ facility, located at 110 Main St. Barnesville, Georgia 30294 . In taking part in the yoga exercises and activities at __Yoga with Kileen_ facility, located at 110 Main St. Barnesville, Georgia 30204 _, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, known or unknown, which might occur as a result of my participation in the yoga exercises and activities.
I recognize that there is risk involved in the types of yoga exercise or activities offered. Therefore I accept financial responsibility for any injury that I may cause either to me or to any other participant due to my conduct, whether such be negligent or otherwise. Should _Yoga With Kileen_, or anyone acting on its or their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless _Yoga With Kileen_, its or their principals, agents, instructors, employees, and volunteers from liability for the injury or death of any person(s) and/or damage to property that may result from my conduct, whether negligent or otherwise, while participating in the yoga exercises or activities offered, regardless of nature, duration, or location.
I have read the above release, waiver of liability and indemnity and hold harmless provisions and fully understand these contents. I am legally competent to sign and voluntarily agree to the terms and conditions stated above.
Print name: _________{name}_______________________
Signature:_____________________________ Date Signed:_____{sign_date}______
If participant is under 18:
I am the Parent or Legal Guardian of _______________________________. I consent to the above terms and conditions.
Print name: ________________________________
Signature:_____________________________ Date Signed:_______{sign_date}_______