Still Waters Wisdom Yoga Program/Class Liability Waiver and Release Form

Please take a moment to fill out the form.

Participant Information:

First Name

Last Name

Code

Phone

Emergency Contact

Emergency Contact Number

Health Disclosure

Please let us know if you have any existing injuries, conditions, or limitations we should be aware of:

Health & Participation Acknowledgment

Please read carefully and check each box to indicate your understanding and agreement. * Required

I understand that yoga involves physical movement and that participation may involve risk of injury.

I affirm that I am physically able to participate and have consulted a physician if necessary.

I agree to listen to my body, practice within my limits, and inform the instructor of any limitations.

I take full responsibility for my health and well-being during classes with Still Waters Wisdom.

Waiver and Release of Liability

Please read carefully and confirm agreement. * Required

I voluntarily waive, release, and discharge StillWatersWisdom, its instructors, directors, volunteers, and affiliates from any and all claims, demands, or liabilities related to my participation.

I agree to indemnify and hold harmless StillwatersWisdom from any liability arising from my involvement in yoga or related activities.

I understand that this waiver applies to all in-person and virtual classes offered by StillWatersWisdom.

Media Release

Choose one option:

I give StillWatersWisdom permission to use photos/videos of me for promotional or educational purposes.

I do not give permission to use photos/videos of me.

Signature and Agreement

Please type your full name as your digital signature.

Today's date: * required

If under 18, a parent or guardian must fill out their name, signature, and today's date.

Parent/Guardian Signature (Full Name):

Today's date:

Final Consent

By checking this box, I acknowledge that I have read, understood, and agree to all the terms of this waiver and release form.

Thanks for submitting!

First Name*

Last Name*

Email*

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Phone

ADDRESS

12137 E Mission Ln,

SCOTTSDALE, AZ 85259, USA

info@stillwaterswisdom.com

Ph#480-939-9694

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Still Waters Wisdom is a registered nonprofit 501(c)3 charity organization.

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