Acknowledgement of Risk

Please fill out the following form to participate in classes

I hereby acknowledge and agree to the following:

1. That I am participating in the Yoga Classes, as well as other online, outdoor exercise fitness routines, Health Programs or Workshops offered by Rebecca Dary of Naturally Wild and Free, LLC during which I will receive information and instruction about yoga, fitness, and health. I recognize that yoga, and other exercise fitness routines require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

 

2. I understand that it is my responsibility to consult with a physician prior to, and regarding my participation in Yoga Classes, as well as other online, outdoor exercise fitness routines, Health Programs, or Workshops offered by Rebecca Dary of Naturally Wild and Free, LLC. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Yoga Classes, as well as online, outdoor exercise fitness routines, Health Programs or Workshops. I understand that it is my responsibility to inform Rebecca Dary with regard to any health condition changes that I experience in the future.

 

3. In consideration of being permitted to participate in Yoga Classes, as well as online, outdoor exercise fitness routines, Health Programs or Workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of my participation.

 

4. In further consideration of being permitted to participate in Yoga Classes, as well as online, outdoor exercise fitness routines, Health Programs or Workshops, I knowingly, voluntarily and expressly waive any claim I may have against Rebecca Dary for injury or damages that I may sustain as a result of participating in the program, and as a result of my negligence in participating in this activity.

 

5. I, my heirs, and/or legal representatives’ forever release waive, discharge and covenant not to sue Rebecca Dary of Naturally Wild and Free, LLC for any injury or death caused by their negligence or other acts.

 

I have read the release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. I realize there are special risks that could be associated with pregnancy, prior surgeries, injuries, and medical conditions that may carry additional health concerns. I have discussed these with my personal physician, and I have obtained his or her concurrence to participate in activities offered by Rebecca Dary. I fully understand that Rebecca Dary is not a medically trained physician or expert in medicine, and therefore, realize that their guidance is limited to the practice of yoga and online, outdoor fitness exercise, and the techniques and routines associated with them.

I have read the above statement and agree:

Thanks for submitting!