Cart 0

Name

First Name

Last Name

Date

Date of Birth

Address

Phone number

Liability Waiver

Jamie Fuller Yoga 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. The exercises related to yoga will challenge my cardio-respiratory and musculoskeletal systems associated with; the aerobic, anaerobic, strength, power, agility, flexibility and breathing components of the program. I understand and am aware that the components of exercise/yoga are potentially hazardous activities and may cause injury. 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 Jamie Fuller and Jamie Fuller Yoga LLC. 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. I, my heirs, or legal representatives, do hereby forever waive and release Jamie Fuller and Jamie Fuller Yoga LLC 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. I understand that Jamie Fuller and Jamie Fuller Yoga LLC may provide an area for personal belongings to be held during class, however, I agree that Jamie Fuller and Jamie Fuller Yoga LLC are in no way responsible for the loss or damage to my belongings while I attend any programs, classes or workshops. 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 Jamie Fuller OR Jamie Fuller Yoga LLC. 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. SIGNATURE: If participant is under 18: As legal guardian of I consent to the above terms and conditions. SIGNATURE of parent/guardian:

Emergency Contact (name and phone #)

If you are a member of any private group or event, you give Jamie Fuller Yoga, LLC permission to add your email and full name to their list of contacts. To not be added, please send an email to Jamie at jamiefulleryoga.com and your information will not be added.