Lana Wilson

Name *

First Name

Last Name

Phone *

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Have you done yoga before?

If Yes, how long and what kind of Yoga?

Yes

No

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

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Agreement of Release and Waiver of Liability *

As a participant of classes offered by Lana Wilson (the “Instructor”), I hereby agree to the following: 1. I understand that yoga requires physical, mental and emotional exertion which may be strenuous and could result in physical injury or damage. As with any physical activity, the risk of injury is always present and cannot be entirely eliminated. I agree to assume the risk and responsibility for any injury or damage, known or unknown, which I might incur as a result of participating in yoga. I, my heirs or legal representatives further agree to irrevocably release and waive any claims made against the Instructor. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga classes. I represent and warrant that I am physically fit enough and I have no medical or physical condition which would prevent my safe participation in yoga classes. Further, I agree to inform the Instructor of any physical limitations, physical discomfort, medical conditions and/or injuries before or during classes. I take full responsibility for any nondisclosure. 3. I will not put my body in any position that does not feel comfortable. If I feel pain I will stop immediately and ask the Instructor for support or modification(s). 4. I understand that from time to time during classes, I may receive hands-on adjustments from the Instructor to correct positions and/or alignment. If I do not want physical adjustments, I will inform the instructor at the beginning of every class I attend. If I do not want to receive a specific adjustment or would like the Instructor to stop adjusting, I will advise the instructor at that time. 5. I agree to the use of any photography and/or videos for promotional purposes for use in publications and advertising by the Instructor. 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. Acceptance herein represents my electronic signature.

I agree to the terms above