NEW CLIENT CONTACT INFORMATION AND RELEASE FORM 

Name :

Birthdate :

Street Address :

City, State, Zip :

Email :

Phone :

Emergency Contact Name :

Emergency Contact Phone: 

I understand that gentle yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. As is the case with any physical activity, the risk of injury (from minor to serious or disabling) is always present and cannot be entirely eliminated. Regarding the gentle yoga and the entire sound bath experience, if I experience any pain or discomfort I will acknowledge my body's cues, discontinue the activity, and ask for support from the instructor/musician I assume full responsibility for any and all damages which may incur through participation. 

Neither yoga or the Sound Bath Experience are a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe with certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in this type of activity. 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 to irrevocably release and waive any claims that I have now or may have hereafter against Yoga Dream Studio, Ethical Asana and its instructors or musicians.

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 law in New York.

Signature:

Date: