Yoga Waiver Form

Retreat Waiver Form

Before joining the Retreat, please take a moment to complete the waiver form below. This form requests your personal details, emergency contact information and any health conditions that may affect your yoga practice.

If you have any questions or concerns, please contact me here

Looking forward to sharing the Retreat with you! Corine 🧘‍♀️✨

I , the student, have voluntarily applied to participate in Yoga classes. I am aware of the physical risks and hazards involved with exercise and I understand that it is my personal responsibility to consult with my GP regarding my participation. I assume responsibility for any risk or injury I may sustain as a result of my participation.

If I am pregnant, I understand that I participate fully at my own risk and that of my unborn child/children.

I understand that Yoga is not a substitute for medical attention, examination, diagnosis, or treatment.

I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class.

I understand that from time to time during yoga classes, the instructor may physically adjust students’ form and posture. If I do not want such physical adjustments, I will inform the instructor upon arrival at this event. I also acknowledge that if I do wish to receive such adjustments, it is my responsibility to inform the instructor when an adjustment has gone as far as I desire at that time.

I agree to discharge Corine Ashton and Stay Zen Yoga from any claim, cause of action or liability relating to any incident that may occur.

Particpants First name

Particpants Last name

Date of Birth

Phone Number

Emergency Contact Name

Emergency Contact Number

Subscribe to mailing list

Yes

Address

Please list anything that the Yoga Instructor should be aware of, including medical concerns:

I agree to the Health Waiver

Sound Bath Disclosure: A session may include crystal singing bowls, chimes, drums, gongs, breathwork, guided meditation, or intuitive guidance. These vibrations are absorbed by the body at a cellular level, impacting your mental, physical, emotional, and spiritual well-being. Sound therapy is not a substitute for medical treatment, and participants should consult a healthcare professional if they have any medical concerns. Sound baths are safe for most individuals, but are not recommended for those with pacemakers, epilepsy, seizures, certain mental health conditions, or in the first three months of pregnancy. People with hearing aids or hearing impairments may experience discomfort. Please consult your healthcare provider to ensure sound baths are safe for you. Temporary discomfort may occur after a session, usually due to toxin release as the body heals. Rest and drink plenty of fluids afterward. By participating, you acknowledge and accept all risks of injury, illness, or property loss associated with the sound bath.

I agree to the Sound Bath Disclosure

I give consent to be photographed or filmed while participating in the yoga class and for the photos and videos to be used by Corine Ashton and Stay Zen Yoga for promotional purposes. I understand that I will not be identified by name, nor will any compensation be extended for such use.

I agree to the Media Consent

Sign with full name

Thanks for completing the waiver form,

I look forward to seeing you in class soon!