Health and Safety Waiver

For your health and safety, please complete the form below before your first yoga class with My Yoga Essence. Form is to be submitted at least 24 hours before your class.

Name *
Please list any health issues/injury and current medications (ensure you mention this to your teacher before the class)
Agreement *
Please advise if you are pregnant or currently taking medication or have any injuries that should be made clear to the teacher. I declare that the above information is correct and I understand that yoga includes physical movements as well as an opportunity for relaxation, and may assist to relief muscular tension. As in the case with any physical activity, the risk of injury may be present and cannot be entirely eliminated. I will not perform any postures to the extent of strain or pain. If I experience any pain or discomfort during or after class, gently come out of the posture and it is my duty to inform the teacher. I will listen and respect the limits of my body at any given day and take a rest at any time during the class as needed. I understand yoga is not a substitute for medical attention, examination, diagnosis or treatment. I should consult a physician prior to beginning any activity program, including yoga. It is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I accept that neither the teacher, nor My Yoga Essence is liable for any injury, to myself, permanent paralysis or death and I take full responsibility of my own actions, or damages, to person or property, resulting from taking the yoga class. All information on this form is kept confidential.