Student Registration

Full Name

Email Address

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RELEASE OF LIABILITY

BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

I have completed the Pre-exercise screening form and have truthfully answered all questions to the best of my ability. I am aware that participation could, in some circumstances, result in physical injury and have discussed my participation, where applicable, with my physician.

In consideration of the acceptance of participation in the program offered by Rise Yoga Canada/Rise Yoga School for myself, my heirs, executors, administrators and assigns, waive any claims to which I may become entitled for injury or damage and WAIVE ANY AND ALL CLAIMS that I have or may in the future against Rise Yoga Canada/Rise Yoga School and its directors, officers, employees, agents and representatives.

TO RELEASE Rise Yoga Canada/Rise Yoga School. From any and all liability for any loss, damage, injury or expense that I may suffer as a result of participating in the exercise programs offered by Rise Yoga Canada/Rise Yoga School due to any cause whatsoever. INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT ON THE PART OF Rise Yoga Canada/Rise Yoga School.

I HAVE READ THIS AGREEMENT AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST RISE YOGA CANADA.

I HAVE READ THIS AGREEMENT AND UNDERSTAND IT.

I agree to the Release of Liability

Medical Questionnaire

1) Has your doctor ever said that you have a heart condition OR high blood pressure?

Yes No

2) Do you feel pain in your chest at rest, during daily activities, or during physical activity?

Yes No

3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?

Yes No

4) Have you ever been diagnosed with another chronic medical condition?

Yes No

5) Are you currently taking prescribed medications?

Yes No

6) Do you have a bone, joint, or soft tissue problem?

Yes No

7) Has your doctor ever said that you should only do medically supervised physical activity?

Yes No