Page 1

Yoga Health Works Participant Consent Form    I, __________________________________, understand completely by participating in a yoga class,  undergoing a personal training session or wellness consultation and/or physical therapy session  that certain physiological changes will occur. Changes that may occur are: joint achiness, elevated  heart rate, blood pressure, muscle soreness, respiratory rate, fainting and heart attack. Every  effort will be made to minimize these changes by the preliminary examination and observation  during the sessions.    I certify that I have provided Yoga Health Works and Agnes F. Schrider with all of my past medical  history and current pertinent medical information to the best of my ability. I understand that I can  stop the classes or sessions at any time that I feel I cannot continue. I hereby waive the right to  make a claim against Yoga Health Works or Agnes F. Schrider. In addition, I hereby  release Yoga Health Works and Agnes F. Schrider from any liability or responsibility for any injury,  accident, illness or lack of income that may result from participation in any of the sessions. I fully  assume all risks that may result in participation in the sessions with Yoga Health Works. This  waiver is intended to be binding upon my family, my heirs and my estate.    I understand that Yoga Health Works will keep the personal information that I have given  confidential and not release it to any form of social media without my approval.       _____ (initial) I ​do not​ wish to receive blogs or fitness newsletters provided by Yoga Health Works.    _____ (initial) I ​do not​ wish any photos or video of me to be on the Yoga Health Works website.        Consent for__________________________________________________________ date ________________  (print your name)      Signature ____________________________________________________________ date ________________               


Yoga Health Works Consent Form  
Yoga Health Works Consent Form  
Advertisement