Stretching for Life, LLC

4160 Elizabeth Lake Road,
Waterford Mi 48328

New Student Information

How did you hear about us?

Medical History: (Please list health conditions, injuries, surgeries:

Yoga History: Have done yoga New to yoga

(If you are currently practicing yoga, please share how long and what style. If you are new to yoga, what are your interests, concerns or questions?):

Emergency Contact (name, relationship, phone #):

RELEASE AND WAIVER OF LIABILITY,

I am participating in yoga/fitness/massage classes during which I will receive information and instruction about fitness and health. As is the case with any physical activity,

including my voluntary participation in yoga, I recognize that yoga/exercise and massage requires physical exertion, which may be strenuous and may cause physical injury and I am fully aware of the risks and hazards involved.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga/fitness and or massage classes. I affirm that I alone am responsible to decide whether to practice yoga. I acknowledge that I have decided to participate in this yoga program voluntarily and do hereby assume all responsibility for my participation in any exercise/yoga, class, workshop, massage or any activity associated with Stretching for Life LLC. I certify that I am physically well and have no medical 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. While engaging in any class or activity operated, organized, arranged or sponsored by Stretching for Life, LLC, either on or off their premises, I shall do so at my own risk. In exchange for receiving Services from Stretching for Life, LLC, I, for myself and on behalf of my heirs, executors, administrators and personal representatives, hereby waive, release, discharge and hold harmless Stretching for Life LLC, its members, officers, employees and agents from any and all liability for any and all injuries, including death, damages or claims relating to or resulting from my receipt of the Services, now or in the future, foreseen or unforeseen. Further, I will indemnify and hold Stretching for Life, LLC, its members, officers, agents and employees, harmless from and against any and all claims, rights, damages, liabilities, losses, costs and expenses (including reasonable attorneys’ fees) arising from or in connection with any injuries to other persons or damage to property caused by or attributed to me by participating in such classes, I agree to assume full responsibility for any risks, injuries or damages known and unknown which I might incur as a result of participating.

As a participant in yoga/fitness classes and/or massage, I knowingly, voluntarily and expressly waive any claim I may have against the instructor, owners or the leaseholder of the building for injuries or damages that I may sustain as a result of my participation in classes or workshops held by Stretching for Life, LLC.

ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

In exchange for permission to participate in Stretching for Life, LLC classes and/or private sessions, including massage. I hereby enter into the following release and waiver of liability, assumption of risk and indemnity agreement and photo release. I, for myself, my heirs, spouse, executors, administrators, personal representatives and assignees, WAIVE, RELEASE, DISCHARGE, INDEMNIFY, HOLD HARMLESS AND AGREE NOT TO SUE Stretching for Life, its officers, directors, managers, teachers, shareholders, employees, agents, landlords, lessees, sponsors, instructors, representatives, volunteers, and affiliates (hereafter the “Released Parties”) from, and against any and all liability, responsibility, damages, losses, claims, demands, actions, suits, judgments, costs and expenses (including attorneys’ fees) resulting from personal injury, accident, illness, death and/or property loss caused in any manner, including theft (personal belongings and otherwise), fire and the simple, active or passive negligence of the Released Parties, by my participation in the Stretching for Life classes and/or massage.

I acknowledge the Yoga classes offered through Stretching for Life are based on the Hatha Style of yoga which uses the breath to guide participants through the various poses. These classes are designed to develop musculoskeletal strength, balance, coordination and flexibility. Participants are advised to move comfortably through the exercises and to work at their individual level of difficulty.

I acknowledge and represent that I have been advised to consult with my physician with respect to any past or present injury, illness, cardiovascular problems, knee problems, back problems, neck problems, osteoporosis, or any other condition that may affect my participation and ability to participate in and to endure the exercise programs, and knowingly assume all risks relating to my participation in the Stretching for Life, LLC studio.

I acknowledge that I have discussed with my physician the appropriateness of the classes offered through Stretching for Life, LLC in connection with any illness or condition that I now have or have previously had and that I knowingly execute this agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

I have read this agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. This agreement is intended to be as broad and inclusive as permitted by law. If any portion of this agreement is held invalid, the remaining portions will continue in full force and effect.

Please read the above information carefully and if you agree to these terms sign below.

[If signing on behalf of a minor]:
Participant is under 18 years of age (parent/legal guardian must sign).