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This is the release form. Please complete all fields within. Thank you.
I (type your name in the box)
1. I am participating in yoga classes, health programs, workshops and/or other
wellness, body work, therapy, exercise and healing arts activities (collectively, the
“Activities”) offered by Chicken Yogi (the“Teacher”). The Activities may be
offered in the physical location of the Studio or offered online by videos, television,
podcasts, apps or other digital media or platforms. All of such offerings, either
physical or online, shall be considered “Activities.”
2. I recognize that I must be in adequate physical and mental health to participate in
the Activities. I understand that the Activities may require intense physical exertion,
and I represent and warrant that I am physically fit enough to participate, and I have
no medical condition which would prevent my full participation in the Activities. I
recognize that the Activities may cause or aggravate a physical injury or medical
condition. I understand that it is my responsibility to consult with a physician before
my participation in the Activities. If I have done so, I have taken the physician’s
advice. I understand that the Teacher reserves the right to refuse my participation in
any Activity on medical, fitness or any other grounds.
3. I am aware that my participation in the Activities could result in high blood
pressure, fainting, heartbeat disorders, physical injury, heart attack or stroke and may
aggravate pre-existing injuries. I understand that I could experience muscle, back,
neck and other injuries as a result of my participation in the Activities. I understand
my physical limitations and I am sufficiently self-aware to stop or modify my
participation in any Activity before I become injured or aggravate a pre-existing
injury.
4. In consideration of being permitted to participate in the Activities, I agree to
assume full responsibility for any risks, injuries or damages, known or unknown,
which I might incur as a result of participating in the Activities, including those which
may result from the negligence of the Teacher.
5. In further consideration of being permitted to participate in the Activities, I
knowingly, voluntarily and expressly waive any “Claim” (as defined below) I may
have against the Teacher and any of Teacher’s employees, independent contractors
or assistants (each, a “Released Party”) that I may sustain as a result of participating
in the Activities even if the Claim arises from the negligence of Released Party or
anyone else.
I agree to indemnify and hold harmless Released Party from any loss, cost, or
liability incurred in defending any Claim made by me or anyone making a Claim on
my behalf, even if the Claim is alleged to or did result from the negligence of
Released Party or anyone else.
“Claim” includes but is not limited to any and all liabilities, claims, demands,
expenses, fees, legal actions, rights of actions for damages, personal injury, mental
suffering and distress, or death that I may suffer, my spouse, children or unborn
child may suffer (including any legal fees or expenses) in connection with
participation in any Activity.
6. I, my heirs or legal representatives forever release, waive, discharge and covenant
not to sue any Released Party for any Claim caused by any negligence or other acts
of any Released Party.
Image Waiver. Please complete the box in the next paragraph.
7. I hereby understand that the Teacher from time to time may photograph, video,
or otherwise record Activities. I Do Do Not
8. This agreement shall be construed in accordance with, and governed by, the laws
of the State of Missouri and that all actions, suits, claims and proceedings
relating to this agreement shall be brought in a court of competent jurisdiction
located in Southern Missouri. In case any provision of this agreement
shall be held invalid, illegal or unenforceable, it shall not affect any other provision
of this agreement and this agreement shall be construed as if such provision had
never been contained herein.
I acknowledge that I have carefully read this agreement and fully understand its
contents. I voluntarily and knowingly agree to the terms and conditions stated
herein. I am aware that by signing this agreement, I am giving up substantial rights,
including my right to sue and certain legal rights my heirs, next of kin, executors,
administrators and assigns may have against any Released Party.
Today's Date:
Signature of participant:
Clear
