Salveo Yoga's Winter Wellness Program

St. Louis Adult and Kids Yoga

Waiver

Please fill out the following form prior to attending any Salveo Yoga Class or Event

First Name

Email Address

Last Name

Date of Birth

Have you discussed practicing yoga with your doctor?

Yes

Have you been hospitalized in the last 12 months?

Yes

Are you currently suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Yoga is a physical exercise. Yoga classes consist of a series of postures that bend, stretch and compress every part of the body. This practice stimulates glands, circulation, respiration and the nervous system.. If you have any physical/medical problems, you must inform your physician and the instructor before beginning class. When performing the exercises, listen carefully and follow the instructor’s directions. DO NOT STRAIN OR FORCE YOURSELF BEYOND YOUR ABILITY. Salveo Yoga and the instructor are not responsible for any injuries or illness resulting from your participation in a Salveo Yoga class. I do hereby waive and release any and all claims for damages I may have against “Salveo Fitness, LLC dba Salveo Yoga”, it’s staff and affiliates for any and all injuries suffered while engaging in the training provided to me. I have read and understood the above. *

Yes I have read the statement above. Check box to confirm you have read, understand and agree to this statement and then sign below.

Electronic Signature

Today's Date

I understand my typed name above constitutes my LEGAL and BINDING signature and has the same representations, force and effect as my manual signature. *

Check this box if you are completing it behalf of your child or dependent

Thanks for submitting!