All information on this sheet is confidential, so it is a request that you be as specific as you can for your own safety and to maximise your potential.
Yes, I would like to receive information via email
Have you had, or do you have (if yes, please give more details):
Blood pressure conditions___________________________________
Eye disorders/ glaucoma____________________________________
Are you pregnant or trying to become pregnant?___________________
REASONS FOR TRYING YOGA
Relaxation body toning strength stress relief weight loss
spiritual meditation flexibility physical ailment
Agreement of release and waiver of liability:
1. I am a participant in yoga classes, workshops or retreats offered by Simone Lambert, during which I will receive information and instruction about yoga and health. I recognise that yoga requires physical exertion. It can be strenuous and may cause physical injury. I am fully aware of the risks and hazards involved. 2. In consideration of being permitted to participate in any yoga classes, workshops or retreats, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating. 3. I understand that during classes instructors may physically adjust me. 4. In further consideration of being permitted to participate in any yoga classes, workshops or retreats I knowingly, voluntarily and expressly waive any claim I may have for any injury or damage that I may sustain as a result of participation. 5. I understand that it is my responsibility to consult a physician prior to and regarding my participation in yoga classes, workshops and retreats. I represent and warrant that I am physically fit and have no medical condition that would prevent my participation in yoga classes, workshops or retreats. 6. I assume all responsibility for all risks of damage or injury that may occur to me as a student participating in yoga classes, workshops or retreats or while using equipment and facilities provided by Simone Lambert, or entering and exiting the premises. 7. I, my heirs, or legal representative forever release, waive, discharge and covenant not to sue Simone Lambert for any injury or death caused by negligence or other acts.
I have read the above release and waiver of liability and fully understand its contents.
I agree to the terms and conditions above.
If under 18 yrs of age:
As legal guardian of ______________________, I consent to the above terms and conditions.