Mindful Movement Participant Name *

First Name

Last Name

I understand that yoga includes physical movements as well as the 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 of disabling, is always present and it cannot be eliminated. If I experience any pain or discomfort, or uncomfortable emotional experience, I will listen to my body and my judgment and ask for support from the group leader or remove myself from the group. I will continue to use the tools I have to relax and to breathe smoothly. I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby irrevocably release and waive any claims that I have now or hereafter may have against this yoga class or any of its instructor. *

Yes

No

Accept text message regarding session date and times? *

Yes

No

Would you consider yourself: *

Not Active

Moderately Active

Very Active