REGISTRATION AND AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

NOTE: Each partner must complete their own release

 

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By clicking "submit" below, you agree to the following Terms & Conditions:

1. That I am participating in the yoga classes offered by Richard Levitt/Theresa Rizzo (herein referred to as Couple’s Yoga) during which I will receive information and instruction about yoga, fitness, and health. I recognize that yoga, and other exercise fitness routines require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of 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 Couple’s Yoga. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in Couple’s Yoga. I understand that it is my responsibility to update this waiver with regard to any health condition changes that I experience in the future.

3. In consideration participating in Couple’s Yoga, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of my participation.

4. In further consideration of participating in Couple’s Yoga, I knowingly, voluntarily, and expressly waive any claim I may have against Couple’s Yoga for injury or damages that I may sustain as a result of participating in the program, and as a result of my negligence in participating in this activity.

5. I, my heirs, and/or legal representatives’ forever release waive, discharge, and covenant not to sue Couple’s Yoga for any injury or death caused by their negligence or other acts.

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. I realize there are special risks that could be associated with pregnancy, prior surgeries, injuries, and medical conditions that may carry additional health concerns. I have discussed these with my personal physician, and I have obtained his or her concurrence to participate in activities offered by Couple’s Yoga. I fully understand that Couple’s Yoga staff are not medically trained physicians or experts in medicine, and therefore, realize that their guidance is limited to the practice of yoga and fitness exercise, and the techniques and routines associated with them.

This agreement shall be governed by the laws of California.

I am not relying on any oral, written, or visual representations or statements made by Couple’s Yoga, including brochures or promotional materials to induce me to participate in this activity.

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.

 


Part 2

 

How did you hear about Couple’s Yoga?

Referred by:
Other:

Please answer the following questions. All information will remain confidential.

1. Are there any illnesses, injuries, or medical conditions that we should know about? Please list them.

2. If yes, do you have any current restrictions that may hinder your ability to participate in Couple’s Yoga?

If you answered yes to question #1 or #2 above, have you checked with your doctor to ensure that it is okay for you to participate?
 Yes No

3. Have you practiced yoga before?
 Yes No

4. If yes, briefly describe your experience.

5. Is there anything you’d like us to know prior to the workshop?