Ebb & Flow Yoga Studio

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Liability Waiver

Please sign and print out the below waiver before your first class with us. Alternatively,

E B B  A N D  F L O W  Y O G A  S T U D I O 

Your Name__________________________________________________________   

Phone(____)__________________________________

Address________________________City________________Zip_____________

Email________________________________________Birth Date_____________

Emergency Contact_____________________Relationship___________________

EmergencyContactPhone(___)____________________________

How did you find out about E&F?__________________________________________________________________

Medical History (Please list all injuries, surgeries, or medical restrictions)

____________________________________________________________________________________________________________________________________

How long have you been practicing Yoga?

First Time______Less than a month_____6-12 months_____Over 1 year_____

I acknowledge that yoga classes can be physically strenuous, and I voluntarily

participate with full knowledge that there is risk to personal injury, property loss, or

death. I am fully aware of the risk and hazards involved. I, my heirs, assigns, and/or

legal representatives waive and release Ebb and Flow Yoga Studio and its teachers,

assistants, and employees from any and all liability and responsibility from any injury,

accident, illness, legal and medical fees sustained now or in the future resulting from my

participation in any activity. I understand that I am giving up my rights to sue or make

any claims of any kind whatsoever against Ebb and Flow Yoga Studio and its teachers,

assistant, and employees for any personal injury, property damage/loss, or wrongful

death, whether caused by negligence or otherwise. I agree to let Ebb and Flow Yoga Studio

 use my photograph, video, and/or waive any rights of compensation or

ownership thereto.

I have read the release and waiver of liability and fully understand its’ contents. I

voluntarily agree to the terms and conditions stated above.

Signature___________________________________________________________          Date_________________________

*If you are under the age of 18, your parent/guardian must sign and return this form prior to

 attending Ebb and Flow Yoga Studio Classes

Parent Signature if needed:_______________________________________________

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