Flourish Yoga

Agreement of Release and Waiver of Liability

First Name

Email Address

Last Name

Date of Birth

It is my responsibility to consult with a physcian and I will inform the yoga instructor of any limitations before participating in a class. I understand that I am fully responsible for any medical issues that may arise. I waive and release Flourish Yoga, Health Golf and Yacht Club, its owners, and instructors from any claims related to my participation in classes offer

Yes

I have not exhibited COVID symptoms or have been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or w/ similar symptoms. I acknowledge the contagious nature of COVID-19 and assume the risk that I may be exposed/infected when attending class and release Heath Golf & Yacht Club, Flourish Yoga, and instructors from any claims resulting in a COVID exposure.

Yes

Emergency Contact Name & Phone #:

My initials serve as an agreement to release and waive liability to Flourish Yoga and HG&YC.

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

(214) 216-2016

Flourish Yoga