Wellness Rebirth LLC
Student Informed Consent and Release Form
Yoga classes taught virtually via Zoom Meetings or live streamed via our website are considered low-risk physical activity, utilizing props for support, and focusing on body awareness. The teacher’s responsibility is to use her knowledge and training to deliver safe instruction and advice. However, there are many factors that influence the effect that yoga will have on an individual based on states of health and fitness. Please note the following to maximize your safety and experience in class:
For students with medical conditions (esp. high blood pressure, detached retina, glaucoma, recent surgery, disc problems or injury), please inform your instructor, and follow any directions your teacher gives regarding modifications for your specific condition(s) during class. Most importantly, listen to your body and if you have pain, let the teacher know-she can help.
Please get your doctor’s approval if you have serious medical conditions, a recent injury or surgery before participating in class.
If you are pregnant, let you instructor know when you register for class.
I, _________________________________________ (print name) understand that yoga includes physical movement, as well as an opportunity for relaxation, stress reduction and relief of muscular tensions. As is the case with any physical activity, the risk of injury, even serious or disabling injury, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will inform my teacher and I will listen to my body. I understand that I may choose to discontinue any pose or activity in class or in my home practice. Wellness Rebirth encourages students to let the instructor know if they experience pain during their class. Modifications, or an alternate pose, can be demonstrated for more comfort and more effective release in a pose.
I understand and accept that yoga is not a substitute for professional medical advice or treatment and that if I have had an injury or have had surgery or if I am pregnant, I should get my doctor’s approval to participate in this yoga class before doing so.
I understand that it is my responsibility to inform the teacher at the beginning of every class that I take if I have any health condition or injury/surgery information that may affect my ability to participate fully in class.
I recognize and accept that it is solely my responsibility to ensure that:
I work at my own pace, do not strain and rest when necessary.
I do not engage in any activity that feels inappropriate.
I am physically able to participate in this yoga class/workshop.
I have given my instructor appropriate information about my physical condition.
There is no medical reason to prevent my participation in this class/workshop.
I accept all responsibility for myself once inside this property.
I have read and understand the above recommendation. I assume full responsibility during and after a yoga session to apply at my own risk, any portion of the information or instruction that I receive. I hereby agree to release and waive any and all claims that I now have or hereafter may have against my instructor, Wellness Rebirth.
Information provided above will be used for Wellness Rebirth’s database only. By supplying above information, you are opting in to receive further communication from Wellness Rebirth. Your information will be kept confidential and it will not be used, sold, or distributed for any other purpose.
Student Signature: _______________________________________________ Date Signed: ____________________________