STUDIO REGISTRATION AND ACTIVITY WAIVER
NAME __________________________________________ DATE OF BIRTH _______________
EMAIL __________________________________________CELL PHONE__________________
HOW DID YOU HEAR ABOUT US? _________________________________________________
NAME __________________________________________ RELATIONSHIP_________________
EMAIL __________________________________________CELL PHONE __________________
MEDICAL RESTRICTIONS/INJURIES ________________________________________________
By voluntary participating as a student of COWFACE YOGA, 501 Church Street NE #108, Vienna Virginia, 20180,
I represent and hereby agree as follows:
I am or will be participating in the Yoga Classes, Pilates Classes, Health Programs and/or Workshops offered by COWFACE YOGA during which I will receive information and instruction about yoga and health. These classes may entail intensive physical activity and exertion by me. I recognize that such physical activity and exertion may be difficult and strenuous and may cause or aggravate a physical injury or medical condition. I am fully aware of and accept the risks and hazards involved.
I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Classes, Pilates Classes, Health Program and/or Workshop, and to receive prior approval to participate. I represent and warrant that I am physically fit and I have no medical condition or injury that would prevent my full participation in the Yoga Classes, Health Programs and/or Workshops.
In consideration of being able to participate in Yoga Classes, Pilates Classes, Health Programs and/or Workshops, I agree to assume all full responsibility for any risks, conditions, injuries or damages, known or unknown, which I might incur or aggravate as a result of my participating. I understand that there may be physical assisting and/or adjustments by the teacher from time to time and that it is my responsibility to let the teacher know if I do not want to be touched/adjusted.
In further consideration of being permitted to participate the Yoga Classes, Pilates Classes, Health Programs or Workshops, I knowingly, voluntarily and expressly waive any claim I may have or acquire against COWFACE YOGA, or the landlord or any premises at which it may operate, for any injury, condition or damages that I may sustain as a result of entering or being on the premises or participating in the Programs.
I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue COWFACE YOGA, or the landlord of any premises at which it may operate for any injury, condition, or death which arise, is caused by or is aggravated by reason of my participation in the Programs.
I understand that it is my continuing responsibility to inform the instructor(s) at COWFACE YOGA of any previous medical conditions, injuries or surgeries prior to my first class and at such other times and I acquire information as to same.
All payments made by me for drop-in classes, class packages, and membership fees are non-refundable and non-transferable. I also state that I have no claims against COWFACE YOGA, or the landlord of the premises by reason of their refusal to allow me to participate in the Programs.
***Please inform teacher of any previous conditions, ailments, injuries and/or surgeries prior to attending your first class. If you are pregnant or may be pregnant, it is your responsibility to consult your physician prior to participating in classes.***
I have read the above Release and Waiver of Liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
YOGA TRAPEZE PARTICIPATION: Waiver & Release of Liability
I represent and hereby agree as follows:
I represent that I am physically capable of participating in the hands on demonstration of Yoga Trapeze as provided by Cowface Yoga Studio.
I understand that Yoga Trapeze and physical exercise can be strenuous and subject to risk of serious injury and I have been fully advised that no exercise, activity, or yoga program should be taken without the consent of a doctor or physician and I am responsible for undertaking to obtain such consent.
I agree that I am voluntarily participating in the hands on demonstration of Yoga Trapeze, in the use of trapeze equipment on premise, as provided by Cowface Yoga Studio, and I assume all risks of injury, illness, etc.
I agree that Cowface Yoga Studio, and assigns shall not be liable or responsible for any injuries to me which may occur as a result of
my use of all Yoga Trapeze equipment provided by at Cowface Yoga Studio and my participation in any hands on demonstration
the sudden and unforeseen malfunctioning of any equipment, swings, handles, and/or otherwise
Yoga Trapeze instruction, training, and supervision
**Minimum Health Requirements:
All levels, ages, and body types are welcome. Students must be in good health, and in proper physical condition to participate in such activity.
Students with the following physical limitations/conditions should consult their doctor AND obtain approval letter prior to participating in Yoga Trapeze fitness:
*Easy onset vertigo, heart disease, pregnancy, very high or low blood pressure, glaucoma, severe arthritis, artificial hip, cerebral sclerosis, disc herniation or acute discogenic disease, hiatal hernia, severe muscle spasms, carpal tunnel syndrome, radiculitis (inflammation of nerve root in spine), sinusitis or tendinitis, osteoporosis / bone weakness, recent head injury, propensity for Fainting, Sinusitis or head cold, recent stroke, botox (within 6 hours), and any recent surgeries (esp. shoulder, eyes, back, hips, hands or wrist)*
**We reserve the right to not demonstrate to students with cardiovascular disease, high blood pressure/hypertension, glaucoma, and/or taking prescription muscle relaxants
I acknowledge that I have read this Yoga Trapeze Waiver and Release and understand that it is a RELEASE OF LIABILITY.
NAME ___________________________________________________ DATE _________________