Yoga Waiver | Kelly Mortensen

Yoga Intake & Liability Waiver

Please complete the following intake & waiver prior to your session. Share any information that will support a comfortable and safe practice. You only need to do this once, unless your health information has changed.

First & Last Name

Phone

Please specify any conditions, injuries and/or discomfort you may be experiencing that you feel I should know about. If none, write NA.

Tell me about your practice. What brought you to yoga and what would you like to gain by practicing with me?

Is there anything else you'd like me to be aware of?

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

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Please type your initials to verify that you have read and accepted the terms and conditons.

Thanks for submitting!