Yoga/Pilates Waiver & Release Form
ASSUMPTION OF RISK AND RELEASE OF LIABILITY
I, the participant specified below, have enrolled in a group/personal Yoga/Pilates program offered by Intrinsic Mind Holistic Health & Wellness. I understand that the Yoga/Pilates program includes but not limited to, physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this program.
I, the participant specified below, acknowledge that my enrolment and subsequent participation is
purely voluntary and in no way mandated by Intrinsic Mind Holistic Health & Wellness. I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my session. I understand that at any time during the program should I feel light-headed, faint, dizzy, nauseated, or experience pain or discomfort, I am to gently come out of the posture and stop the activity. I also understand that I can ask for support from the instructor at any time.
In consideration of my participation in this program, I hereby release Intrinsic Mind Holistic Health & Wellness and its principals, agents, employees, trainers, and volunteers from any claims, demands, and causes of action as a result of my voluntary participation and enrolment.
I, the participant specified below, fully understand that I may injure myself as a result of my enrolment and subsequent participation in this program and I hereby release Intrinsic Mind Holistic Health & Wellness and its agents from any liability now or in the future for conditions or injuries that I may obtain. These conditions and injuries may include, but are not limited to, muscle strains, muscle pulls, muscle tears, heat prostration, anxiety, fears, injuries to knees, injuries to back, or any other illness or soreness that I may incur.
I, the participant specified below, understand that Yoga/Pilates is not a substitute for medical attention, examination, diagnosis or treatment. Yoga/Pilates is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program, if required. In addition, I will make the instructor aware of any medical conditions or physical limitations before the program. If I am pregnant, become pregnant, am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate.
EMERGENCY MEDICAL SERVICES
I, the participant specified below, give permission for Intrinsic Mind Holistic Health & Wellness staff and trainers to seek emergency medical services for me should I become injured or ill, with the understanding that I am responsible for any expense incurred. If I am signing on behalf of a minor child, I also give full permission for any person connected with Intrinsic Mind Holistic Health & Wellness to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child.
INDEMNITY
I, the participant specified below, accept financial responsibility for any injury that I may cause either to myself or to any other participant due to my negligence. I further agree to indemnify and hold harmless Intrinsic Mind Holistic Health & Wellness, their principals, agents, employees, trainers, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Intrinsic Mind Holistic Health & Wellness. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent and/or any area selected for training by Intrinsic Mind Holistic Health & Wellness.
PHOTOGRAPHY OR VIDEOGRAPHY
I, the participant specified below, acknowledge that I may be photographed or videotaped during
training. I hereby consent to the use of these photographs and/or videos without compensation, on
the Intrinsic Mind Holistic Health & Wellness website or in any editorial, promotional or advertising material produced and/or published by Intrinsic Mind Holistic Health & Wellness.
**IMPORTANT NOTE**
I am aware that this agreement is ongoing and will apply to all future occasions I participate in activities and training with or at the direction of Intrinsic Mind Holistic Health & Wellness.
This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.
I have read and understood the above statements. I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission.
I, the participant specified below, have enrolled in a group/personal Yoga/Pilates program offered by Intrinsic Mind Holistic Health & Wellness. I understand that the Yoga/Pilates program includes but not limited to, physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this program.
I, the participant specified below, acknowledge that my enrolment and subsequent participation is
purely voluntary and in no way mandated by Intrinsic Mind Holistic Health & Wellness. I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my session. I understand that at any time during the program should I feel light-headed, faint, dizzy, nauseated, or experience pain or discomfort, I am to gently come out of the posture and stop the activity. I also understand that I can ask for support from the instructor at any time.
In consideration of my participation in this program, I hereby release Intrinsic Mind Holistic Health & Wellness and its principals, agents, employees, trainers, and volunteers from any claims, demands, and causes of action as a result of my voluntary participation and enrolment.
I, the participant specified below, fully understand that I may injure myself as a result of my enrolment and subsequent participation in this program and I hereby release Intrinsic Mind Holistic Health & Wellness and its agents from any liability now or in the future for conditions or injuries that I may obtain. These conditions and injuries may include, but are not limited to, muscle strains, muscle pulls, muscle tears, heat prostration, anxiety, fears, injuries to knees, injuries to back, or any other illness or soreness that I may incur.
I, the participant specified below, understand that Yoga/Pilates is not a substitute for medical attention, examination, diagnosis or treatment. Yoga/Pilates is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program, if required. In addition, I will make the instructor aware of any medical conditions or physical limitations before the program. If I am pregnant, become pregnant, am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate.
EMERGENCY MEDICAL SERVICES
I, the participant specified below, give permission for Intrinsic Mind Holistic Health & Wellness staff and trainers to seek emergency medical services for me should I become injured or ill, with the understanding that I am responsible for any expense incurred. If I am signing on behalf of a minor child, I also give full permission for any person connected with Intrinsic Mind Holistic Health & Wellness to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child.
INDEMNITY
I, the participant specified below, accept financial responsibility for any injury that I may cause either to myself or to any other participant due to my negligence. I further agree to indemnify and hold harmless Intrinsic Mind Holistic Health & Wellness, their principals, agents, employees, trainers, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Intrinsic Mind Holistic Health & Wellness. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent and/or any area selected for training by Intrinsic Mind Holistic Health & Wellness.
PHOTOGRAPHY OR VIDEOGRAPHY
I, the participant specified below, acknowledge that I may be photographed or videotaped during
training. I hereby consent to the use of these photographs and/or videos without compensation, on
the Intrinsic Mind Holistic Health & Wellness website or in any editorial, promotional or advertising material produced and/or published by Intrinsic Mind Holistic Health & Wellness.
**IMPORTANT NOTE**
I am aware that this agreement is ongoing and will apply to all future occasions I participate in activities and training with or at the direction of Intrinsic Mind Holistic Health & Wellness.
This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.
I have read and understood the above statements. I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission.
