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:_______________________________________________