Name _______________________________

Home # _______________ Work # ____________ Email: ___________________

Birth date: _____________   Male/Female: ________  Marital Status: _________

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I______________________________ hereby agree to the following:

1.  That I am participating in Yoga/Pilates classes during which I receive information and instruction about Yoga/Pilates and health. I recognize that yoga/pilates requires physical exertion, which 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 the yoga/pilates classes. I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the yoga/pilates classes.

3.  In consideration of being permitted to participate in the yoga/pilates classes, I agree to assume full responsibility for any risks, injuries, or damages known or unknown, which I might incur as a result of participating in the Program.

4.  In further consideration of being permitted to participate in the yoga/pilates classes, I knowingly, voluntarily and expressly waive any claim I may have against Yoga Legacy, LLC and/or my yoga/pilates instructor or that I may sustain as a result of participating in the Program.

5.  I, my heirs, or legal representatives forever release, waive, discharge and covenant not to sue Yoga Legacy LLC and/or my yoga instructor for any injury or death caused by their negligence or other acts.

Date __________________                                            

________________________________________

Signature of participant.