Child Liability Waiver Form

Parent Name/Legal Guardian

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Mobile Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's Full Name

Child's Grade

School

Does your child have any physical limitations that we should be aware of?

Does your child have any allergies to fragrances or plant essences? (We may diffuse lavender or mist lavender (Magic Mist) during class or relaxation time.)

Please read and sign the liability waiver & release form below:

LIABILITY CLAUSE:

This is to certify that I, ____(signed below)________, do consent and agree to be bound by this Liability Waiver and Release for ANY class taken by me from this date forward. I understand that yoga involves physical and athletic movements that can result in injury. I accept these risks and agree to waive the liability of all parties involved in the yoga classes, inclusing but not limited to Kathleen J. Belonga, Janna Conybeare, Mindful Living & Yoga, LLC., the owner(s) of the host studio or other class location and all of their shareholders, directors, officers, employees, representatives and agents (the “Released Parties”). I further release and agree to indemnify and hold harmless the Released Parties from any and all loss, claim, injury, damage or liability pertaining to me or my child’s involvement or participation in this class or any future class, to the fullest extent permitted by law.

MEDICAL RELEASE:

I hereby give consent for emergency medical treatment and care by a licensed doctor or dentist or emergency responder. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my child or me.

PHOTOGRAPHY RELEASE:

I understand that my child or I may be photographed while having fun in yoga class. The photographs are the property of Mindful Living & Yoga, LLC, and no compensation will be given to my child or me if these photographs are used in social media or marketing materials. I also understand that I may request in writing, via email: kathleen.belonga@me.com, a digital copy of any photographs taken of my child or me.

I agree to allow my child to participate in yoga class. I have read and agree to all of the above statements, including the liability waiver and release.

Minor Student Liability Waiver & Release Form