LIABILITY WAIVER
New Student Information
Name: ___________________________________________________________
Address: _________________________________________________________
City: ____________________ State: ______ Zip Code: ____________________
Primary Phone: ____________________________________________________
E-mail: __________________________________________________________
Emergency Contact Name: ___________________________________________
Emergency Contact Phone: ___________________________________________
Date of Birth: _______________ Today's Date: ____________________________
Waiver of Liability & Disclosure Form
I understand there is an inherent risk associated with any exercise program including my voluntary participation in yoga that may result in injury. I understand and am aware that the components of exercise/yoga are potentially hazardous activities and may cause injury.
1. I acknowledge that I have either had a physical examination and/or have been given permission from my physician to participate in a yoga based exercise program or that I have decided to participate in an exercise program voluntarily and without the approval of my physician and do hereby assume all responsibility for my participation in any exercise/yoga or activity associated with SoulFire Collective studio.
2. I certify that I am physically well and suffering from no medical problems, conditions, impairments, diseases, or any other illness that would prevent my full participation or increase my risk of injury and/or illness as a result of partaking in any exercise/yoga program or other activities or workshops.
3. I, my heirs, or legal representatives, do hereby forever waive and release SoulFire Collective, its members, teachers, agents and employees from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from my participation in any exercise/yoga activity, workshops or use of any equipment.
4. I understand that SoulFire Collective may provide an area for personal belongings to be held during class, however, I agree that SoulFire Collective is in no way responsible for the loss or damage of my belongings while I attend any programs, classes or workshops.
5. I acknowledge that I have read this waiver of liability form. I fully understand its terms and conditions, and understand that I am waiving and giving up my right to sue SoulFire Collective, its teachers, members, agents and employees. I acknowledge that I am signing this agreement voluntarily, and intend by my signature for this to be a complete and unconditional release of liability to the greatest extent allowable by law.
Photo Release Form
I hereby grant the SoulFire Collective permission to use my likeness in a photograph, video, or other digital media ("photo") in any and all of its publications, including web-based publications, without payment or other consideration.
I understand and agree that all photos will become the property of the SoulFire Collective and will not be returned.
I hereby irrevocably authorize the SoulFire Collective to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge the SoulFire Collective from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Signature ____________________________________ Date ________________
If participant is under 18: As legal guardian of __________________________, I consent to the above terms and conditions.
Signature of parent/guardian ___________________________________ Date _________________
Cancellation Policy
YOU, THE BUYER, MAY CANCEL THIS CONTRACT AT ANY TIME WITHOUT ANY PENALTY OR OBLIGATION. If you wish to cancel by written notice, please send an email to Soul Fire Yoga LLC at INFO@SOULFIRECOLLECTIVE.COM at any time.
You may also cancel this contract if this spa moves or goes out of business and fails to provide equal facilities within 15 miles of the location designated in this contract.
