Release & Liability Waiver Form

First Name:                                                                             Last Name:                                                                        

 

Street Address:                                                                                                                                                                  

 

City, State & Zip Code:                                                                                                                                                     

 

Phone Number:                                                                       Email Address:                                                                 

 

I,                                                                                                                                          , hereby agree to the following:

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1. I'm participating in yoga classes, health programs, workshops and/or other wellness, bodywork, therapy, exercise and healing arts activities (collectively, “Activities”) offered by Suz Brick (the “Teacher”). Activities may be offered in a physical location, such as a Studio, or offered online by videos, television, podcasts, apps or other digital media or platforms. All of such offerings, either physical or online, shall be considered “Activities.”
    

2. I recognize that I must be in adequate physical and mental health to participate in Activities. I understand that Activities may require intense physical exertion, and I represent and warrant that I'm physically fit enough to participate, and I have no medical condition which would prevent my participation in Activities. I recognize that Activities may cause or aggravate a physical injury or medical condition. I understand that it's my responsibility to consult with a physician before participating in Activities. If I've done so, I've taken the physician’s advice. I understand that the Teacher reserves the right to refuse my participation in any Activity on medical, fitness or other grounds.
    

3. I'm aware that my participation in Activities could result in high blood pressure, fainting, heartbeat disorders, physical injury, heart attack or stroke and may aggravate pre-existing injuries. I understand that I could experience muscle, back, neck and other injuries as a result of my participation in Activities. I understand my physical limitations and I'm sufficiently self-aware to stop or modify my participation in any Activity before I become injured or aggravate a pre-existing injury.
    

4. In consideration of being permitted to participate in Activities, 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 Activities, including those which may result from the negligence of the Teacher.
    

5. In further consideration of being permitted to participate in Activities, I knowingly, voluntarily and expressly waive any “Claim” (as defined below) I may have against the Teacher and any of Teacher’s employees, independent contractors or assistants (each, a “Released Party”) that I may sustain as a result of participating in Activities even if the Claim arises from the negligence of Released Party or anyone else.
   
   I agree to indemnify and hold harmless Released Party from any loss, cost, or liability incurred in defending any Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or did result from the negligence of Released Party or anyone else.
   
   “Claim” includes, but is not limited to, any and all liabilities, claims, demands, expenses, fees, legal actions, rights of actions for damages, personal injury, mental suffering and distress, or death that I may suffer, my spouse, children or unborn child may suffer (including any legal fees or expenses) in connection with participation in any Activity.
    

6. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any Released Party for any Claim caused by any negligence or other acts of any Released Party.
    

7. I hereby understand that the Teacher from time to time may photograph, video, or otherwise record Activities and place such photographs and videos on its Website or social media platforms. I hereby consent to the use of my image that may appear in any such photograph or video.
    

8. This agreement shall be construed in accordance with, and governed by, the laws of the State of Washington and that all actions, suits, claims and proceedings relating to this agreement shall be brought in a court of competent jurisdiction located in Vancouver, Washington. In case any provision of this agreement shall be held invalid, illegal or unenforceable, it shall not affect any other provision of this agreement and this agreement shall be construed as if such provision had never been contained herein.

 

I acknowledge that I've carefully read this agreement and fully understand its contents. I voluntarily and knowingly agree to the terms and conditions stated herein. I'm aware that by signing this agreement, I'm giving up substantial rights, including my right to sue and certain legal rights my heirs, next of kin, executors, administrators and assigns may have against any Released Party.

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Signature of Participant:                                                                        Date:                                                                  

 

If Participant is under 18:

 

As Legal Guardian of                                                              , I consent to the above Release & Waiver of Liability.

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Signature of Parent/Guardian:                                                                   Date: