CPLF%Adapted%Hatha%Yoga%-%Waiver%&%Release%Form%
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Name:%___________________________________________%Age:%______%%
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%Birth%Date:%_____/____/______%
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%Address:%____________________________________________________%%
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%City:%________________________________________%Postal%Code:%___________%
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%Emergency%Contact%Name:%________________________________________%
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%Emergency%Contact%Phone:%________________________________________%
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%I%unde rs ta n d %t h at %yo g a %in clu d e s %p h ys ica l%movements%as%well%as%an%opportunity%for%relaxation,%stress%re-
education%and%relief%of%muscular%tension.%As%is%the%case%with%any%physical%activity,%the%risk%of%injury,%even%
serious%or%disabling,%is%always%present%and%cannot%be%entirely%eliminated.%If%I%experience%any%pain%or%
discomfort,%I%will%listen%to%my%body,%discontinue%the%activity,%and%ask%for%support%from%the%instructor.%I%
will%continue%to%breathe%smoothly.%I%assume%full%responsibility%for%any%and%all%damages,%which%may%incur%
through%particip ation .%%
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%Yoga%is%not%a%substitute%for%medical%attention,%examination,%diagnosis%or%treatment.%Yoga%is%not%
recomm en d ed %and %is%not%sa fe%un d er%certa in%m e dica l%con ditio ns.%By %signin g,%I%affirm%th at%a%licen se d%
physician%has%verified%my%good%health%and%physical%condition%to%participate%in%such%a%fitness%program.%In%
addition,%I%will%make%the%instructor%aware%of%any%medical%conditions%or%physical%limitations%before%class.%
If%I%am%pre g n a n t,%b e co me%pregn a n t%o r %I%am%post-natal%or%post-surgical,%my%signature%verifies%that%I%have%
my%physician's%approval%to%participate.%I%also%affirm%that%I%alone%am%responsible%to%decide%whether%to%
practice%yoga%and%participation%is%at%my%own%risk.%I%hereby%agree%to%irrevocably%release%and%waive%any%
claims%that%I%have%now%or%may%have%hereafter%against%CPLF%and%the %instruc tor.%
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%I%have%r ea d %a n d %fu lly %u n d e rst a n d %an d%agree%to %th e %above%term s %o f%t h is%L ia b ility %Waiver%Agr ee ment.%I%am %
signing%this%agreement%voluntarily%and%recognize%that%my%signature%serves%as%comp lete%and%
unconditional%release%of%all%liability%to%the%greatest %ex te n t%a llo w e d %b y%la w %in %t he %P ro v inc e %o f%A lb er ta .%
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Client%Signature:%_________________________________%%%%%%%%%%%%%%%%%Date:_______________________%
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Guardian%Signature:%______________________________%%%%%%%%%%%%%%%%%Date:%_______________________%
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Support%Staff%Signature:%____________________________%%%%%%%%%%%%%%%Date:________________________%
