Indemnity Form Full Name Email Address Phone Number Emergency Contact (name, relation, and contact number) Have you practised yoga before? If yes, for how long? Limitations/Injuries Do you have numbness/pain in: Neck Shoulders Wrists Hips Lower Back Upper Back Knees Other If other, please note: If at anytime during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day. I, the undersigned, understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will not perform any postures to the extent of strain or pain. I accept that neither the instructor nor the hosting facility, is liable for any injury, damage, loss and/or theft to a person or property, resulting from the taking of the class. Those under 18 years of age must have this form signed by a parent or guardian. Name of Parent/Guardian (required for minors) Date Send