Online Waiver — Bre Allison

Group Class & Workshop Waiver

Name

First Name

Last Name

If you paid for multiple participants, please include name and email below

Please list any mental or physical health considerations

This ranges from injuries, high blood pressure, pregnant, trauma recovery, chronic pain, physical limitations, post cancer treatment, bipolar etc.

Recording consent

1. If recording is in a gallery view showing all participants, I allow myself to be recorded in whatever capacity I am showing up. This includes my video if using, audio if I take myself off mute, my name if it is posted and video is off. I also allow this recording to be shared to other participants. 2. I prefer to be completely removed from any aspect of the recording and if I have a question, I will take responsibility to type the question in the chat box instead of unmuting to ask a question.

Any other questions, comments or concerns

Check all that apply

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I agree to keep myself safe, not hurt myself or anyone else during the session.

Since I understand, that I am completely responsible for my participation, process, and well being, I agree to release and hold harmless the released party. I have read & agree to the liability waiver

Waiver of Liability: "Yoga consultant" means Breana Allison and is the released party. Yoga is the application of the principles and practices of yoga to promote health and well-being. Its aim is to eliminate, reduce, and/or manage symptoms that cause suffering; improving function; helping to prevent the occurrence or re-occurrence of underlying causes of illness; and moving toward improved health and well-being. I understand that the yoga consultation I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during the session, I will immediately inform the consultant so that the technique may be adjusted to my level of comfort. I further understand that a yoga consultation should not be construed as a substitute for medical examination, diagnosis or treatment. I understand that yoga consultants are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because yoga consultations should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the yoga consultant updated as to any changes in my medical profile during the session and understand that there shall be no liability on the yoga consultant’s part should I fail to do so. This consent is applicable for future sessions with the yoga consultant if a new waiver is not required for participation; I agree to update the yoga consultant with any changes to my medical profile for future sessions and take full responsibility in failure to do so. I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. I also understand that the yoga consultant reserves the right to refuse a session to anyone whom he/she deems to have a condition for which the techniques of yoga are contraindicated.

I attest that my typed name is my signature.

Date

YYYY

Emergency Contact

Name & phone number