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Yoga Class Waiver

To participate please complete and submit this agreement.

Thank you!

First Name

Email Address

Last Name

Date of Birth (must be 18 years of age, or accompanied by parent/guardian)

Do you have doctor’s permission to practice wth and/or receive treatments by Rosie? *

No

Yes

As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. If I experience any pain or discomfort I will immediately stop practicing, and inform the teacher. I affirm that I alone am responsible to decide whether to participate. *

Agree

Disagree

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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