HEALTH WAIVER

Please fill out the following form to help us understand your physical condition.

First Name

Email Address

Last Name

Date of Birth

Are you currently suffering from a medical condition, illness, or injury? If yes, please elaborate so the instructors my consider your condition and offer modifications.

Any participant attending class is solely responsible for ensuring their own physical condition and overall health is suitable for practicing yoga or other comparable physical activities. Please consult your physician prior to participating in any exercise routine.

By signing the below, I hereby agree to the following:

I am participating in classes or services that require physical exertion which may be strenuous and pose a risk of physical injury and I am fully aware of the risks and hazards involved.
I understand it is my responsibility to consult with a physician prior to and regarding my participation in any fitness program. I represent and warrant that I have no medical conditions that would prevent my participation in activities offered at Pink Moon Yoga & Wellness.
I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participation.
I knowingly, voluntarily, and expressly waive any claim that I may have against the instructor, business owner(s), or building owner for injuries or damages that I may sustain as a result of participating in classes, workshops, or services held at Pink Moon Yoga & Wellness.
I agree to observe all necessary precautions to avoid transmission of the COVID-19 virus and further agree to follow all studio policies and procedures put in place related to the COVID-19 pandemic. I acknowledge that I will otherwise be denied access to class.

Emergency Contact

Initials

Phone

Today's Date

I certify that the above information is accurate to the best of my knowledge.

Thanks for submitting!

HEALTH WAIVER

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