STUDENT REGISTRATION AND ACTIVITY WAIVER

NAME  __________________________________________ DATE OF BIRTH _______________

EMAIL  __________________________________________CELL PHONE__________________

HOW DID YOU HEAR ABOUT US?  _________________________________________________

By voluntary participating as a student of COWFACE YOGA, 501 Church Street NE #108, Vienna Virginia, 20180, 

I represent and hereby agree as follows:

1. I am or will be participating in the Yoga Classes, 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.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Classes  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.

3. In consideration of being able to participate in Yoga Classes, 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.

4. In further consideration of being permitted to participate the Yoga Classes, 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.

5. 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.

6. 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.

7. 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.

NAME  ___________________________________________________   DATE _________________

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NAME  ______________________________________________________

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