top of page
Log In
Home
About Me
Waiver
Contact
More
Use tab to navigate through the menu items.
Participant Release & Waiver of Liability
First Name
Last Name
Email
Birthday (Optional)
Do you consent to the use of photos of you in print, digital and/or social media?
*
No
Yes
Please specify anything existing injuries or limitations I should be aware of:
I hereby agree that I am voluntarily participating in yoga and meditation practices (the “Practices”) offered by Russell Dog Yoga, LLC and Heather Jo Allen. I recognize that I must be in adequate physical and mental health to participate in the Practices. I understand that the Practices may require intense physical exertion, and I represent and warrant that I am physically fit enough to participate in the Practices and that I have no medical condition which would prevent my full participation in the Practices. I recognize that the Practices may cause or aggravate a physical injury or medical condition. I understand that it is my responsibility to consult with a physician before participating in the Practices. If I have done so, I have taken the physician’s advice. I understand that Russell Dog Yoga, LLC and Heather Jo Allen reserve the right to refuse my participation in any Practices on medical, fitness, or any other grounds. I understand my physical limitations, and I am sufficiently self-aware to stop or modify my participation in any Practices before I become injured or aggravate a pre-existing injury. In consideration of being permitted to participate in the Practices, 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 Practices.
In consideration for being permitted to participate in the Practices and understanding the risks of the Practices, I hereby release Russell Dog Yoga, LLC and Heather Jo Allen from any responsibility and/or liability concerning my participation in the Practices in which I elect to participate. In further consideration for being permitted to participate in the Practices, I knowingly, voluntarily, and expressly waive any claim that I may have against Russell Dog Yoga, LLC and Heather Jo Allen for injuries or damages that I may sustain as a result of participating in the Practices.
I declare that the information I’ve provided is accurate & complete.
Your Signature
Clear
Submit
Thank you! Sat Nam!
bottom of page