Waiver and Medical Conditions “Awake my Dear ~ Be Kind to your sleeping heart. Take it out into the vast fields of Light and let it breathe.” Hafiz Waiver & Medical Conditions form Join Our Journey Medical Waiver Please complete this form before attending your class or webinar. This form must be completed BEFORE attending instruction. Name Name First First Last Last Address * City * Postal Code * Phone * Email * Type of Instruction Type of Instruction * Weekly Class Workshop Online Webinar Retreat Program Private Session Medical Conditions Please indicate any conditions that apply to you * Heart Condition Epilepsy Irregular Heart Beats Respiratory Condition High or Low Blood Pressure Asthma (Inhaler?) High Cholesterol Chest Pain Varicose Veins Headaches Allergies (Epipen?) PMS Skin Conditions Peri/Menopausal Symptoms Dizziness or Fainting spells Arthritis (Rheumatoid, Osteo) Blurred Vision Joint Replacements Ringing in Ears Joint or Bone Problem/Pain Muscles aches or pains Insomnia Sleep Apnea Diabetes Digestive Problems Back Pain Nausea Vomiting Heartburn Constipation or Diarrhea or IBS Leaky Gut Slow Digestion Spinal Pathologies: Discs Issues, Stenosis, Scoliosis,Spondylolysis, Osteoporosis, Kyphosis Kidney/Liver Condition Urinary Tract Problems Herni High Level of Stress/Distress Depression / Anxiety Surgery Nervousness Lack of mental clarity Surgical Implants Surgical Scars Taking Medication Compromised from past surgery Unexplained Symptoms NONE of the above Comments about your condition Emergency Contact Info Name Name First First Last Last Phone Relationship WAIVER and RELEASE OF INDEMNITY * 1. Waiver of Right to Sue: I waive any and all claims I may now and in the future have against, and release and forever discharge from all liability, and agree not to sue the teacher and all other representatives for any personal injury, death, property damage or loss sustained by me as result of my participation the Yoga Class due to any cause whatsoever, including without limitation, active or passive negligence, imprudence, lack of skill, error of judgment, breach of contract, or breach of statutory duty of care on the part of the Teacher or any representative. I am in sufficient physical condition to participate in the Class and am aware that participation could, in some circumstance, result in physical injury. 2. Indemnity: I agree to save harmless and indemnify the Teacher from and against any and all liability for any Loss to any third party, resulting from my participation in the Class. 3. Read and Understood and Age of Majority: I have read and understood this Waiver and Release of liability and Indemnity prior to signing in it and agree that this instrument will be binding on me and my heirs, executors, administrations and assigns. I am of the full Age of Majority. Additional Zoom Waiver * By using the online video service (eg. ZOOM), you represent that you understand that physical exercise involves strenuous physical movement, and that such activity carries the risk of injury whether physical or mental. You understand that it is your responsibility to judge your physical and mental capabilities for such activities. It is your responsibility to ensure that by participating in classes, courses, programs, and activities from Sharon Abbondanza (dba Inspiring Yoga), you will not exceed your limits while performing such activity, and you will select the appropriate level of activity for your skills and abilities, as well as for any mental or physical conditions and/or limitations you have. You understand that, from time to time instructors may suggest exercises and postures and it is your sole responsibility to determine if any such suggestion is appropriate for your level of ability and physical and mental condition. You expressly waive and release any claim that you may have at any time for injury of any kind against Sharon Abbondanza, or any person or entity involved with Sharon Abbondanza, including without limitation its principals, instructors, independent contractors, employees, agents, contractors, affiliates and representatives. Signature * signature keyboard Clear If you are human, leave this field blank. Submit Copyright Inspiring Yoga 2023 | Terms of Use | Privacy Policy | Site created and managed by ASC Creative Ltd.
