Online Indemnity Form

Lets try and save time and paper with this online form:

Name(required)

Contact Number(required)

Time(required)

Have you been to us before?(required)

Email(required)

How did you hear about us?(required)

Please elaborate:

Have you practised Yoga before?(required)

Any Medical conditions/injuries i should know about?(required)

Please explain:

Indemnity:I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation. I understand Yoga is not a substitute for medical attention, examination, diagnosis or treatment and that Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree toirrevocably release and waive any claims that I have now or may have hereafter against “Greenleafvitality” and it's instructors. I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by the law in South Africa. I understand that the instructions given throughout the classes are intended as guidance only. I understand that yoga needs to be practiced with awareness. I understand that while all due care will be taken by the instructor; they cannot be responsible for my improper practice at any time. To ensure that no personal injury occurs, I agree to adjust my practice according to my limitations and the decision to perform any yoga postures and practices remains mine. I declare that I will take full responsibility for myself during the classes. I will notify my instructor before each class begins of any recent injury, illness, surgery or pregnancy. I will not hold GREENLEAFVITALITY responsible for theft of or damage to any of my belongings brought onto the property and this is at my own risk.

Address, City(required)

Emergency Contact(required)

Emergency Contact Name(required)

I accept the terms and Conditions(required)

Full Name(required)

Preferable days and times. Please state 3 if possible. (required)

Do you prefer heated or none heated Yoga?

Age

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