Yoga Student Informed Consent & Release Form

Name *

First

Last

Contact Number

Emergency Contact Number

Email *

Pre-existing Conditions

Please inform your teacher of any pre-existing conditions you may suffer (high blood pressure, disc problem, physical limitations and injuries etc), or any recreational or medical substances being taken, including antidepressants, muscle relaxants, psychotropic drugs etc.

Please list any physical limitations/injuries/surgeries/medical conditions

Please list any recreational or medical substances being taken and what for

Why have you decided to attend a yoga class? (Reason/expectations)

Consent

I understand that yoga includes physical movement, as well as an opportunity for relaxation, stress reduction and relief of muscle tensions. As in the case with any physical activity, the risk of injury, even serious or disabling injury, is always present and cannot be entirely eliminated.
If I experience any pain or discomfort, I will inform my teacher immediately and I will listen to my body. I understand that I may choose to discontinue any pose or activity in class or in my home practice.
I understand and accept that yoga is not a substitute for professional medical advice or treatment and that if I have had an injury or have had surgery or if I am pregnant, I need to get my doctor’s approval to participate in this yoga class before doing so.
I have read and understood the above information. I take full responsibility during and after a yoga session to apply at my own risk, any portion of the information or instruction that I receive. I hereby agree to release and waive any and all claims that I now have or hereafter may have against my teacher