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Yoga Bloom Student Information

  • Health Information

  • By submitting this form hereby agree to the following:

    1. That I am participating in the yoga classes or workshops offered by Cora Wen during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

    2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in this yoga class. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in the yoga class, health programs or workshops.

    3. In consideration of being permitted to participate in the yoga class or workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

    4. In further consideration of being permitted to participate in the yoga classes or workshops, I knowingly, voluntarily and expressly waive any claim I may have against Cora Wen or the owner or leaseholder of the building for injuries or damages that I may sustain as a result of participating in the program.

    5. I, my heirs, or legal representative of such forever release, waive, discharge and covenant not to sue Cora Wen or the leaseholder or owner of the building for any injury or death caused by their negligence or other acts.

  • Name of parent/guardian