Yoga Waiver Form

Children's Yoga Liability/Waiver Form

Before your child joins Yoga class, please complete the below waiver form.
The form asks for personal details, emergency contact and any health issues that

may impact Yoga Practice.

Got any questions or concerns? Feel free to contact me here

I, as the parent or legal guardian of the child identified below, consent to his/her participation in Stay Zen Yoga classes. The instructor will take all reasonable care to ensure the classes are fun and safe; however, I understand that my child will be engaging in some physical activity and therefore may involve some risk of injury. I assume these risks and take full responsibility for any personal injury sustained by my child which might occur as a result of participating in this programme.

I agree to discharge Corine Ashton and Stay Zen Yoga from any claim, cause of action or liability relating to any incident that may occur in connection to my child’s participation in the above mentioned yoga class.

Childs First Name

Childs Last Name

Child's Date of Birth

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Contact Number

Primary Address

Please list anything that the Yoga Instructor should be aware of, including medical concerns:

I agree to the Health Waiver

I give consent for my child to be photographed or filmed while participating in yoga class and for the photos and videos which include images of my child to be used by Corine Ashton and Stay Zen Yoga for promotional purposes. I understand that my child will not be identified by name, nor will any compensation be extended for such use.

I agree to the Media Consent

I declare that the info I’ve provided is accurate & complete

Subscribe to mailing list

Yes

Parent/Guardian- Sign with Full Name

Thanks for completing the waiver form,

I look forward to seeing you in class soon!

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