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CHILD EVENT PERMISSION FORM

INFO

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Child's Name *

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Last

Parent or guardian name *

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Last

Event Name *

Any Allergies / Disabilities *

Month *

Day *

Year *

Location *

EMERGENCY CONTACT

Name *

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Last

Phone Number *

Email *

AGREEMENT

I agree and consent to the following: I acknowledge the inherent risk of participating in events, classes or workshops at_Free Spirits Yoga Sayville owned by Fs Yoga Inc and accept any full ownership of of any possible contraction of Covid-19 or any other illness. I knowingly, voluntarily and expressively waive any claim I may have against_Free Spirits Yoga Saville owned by Fs Yoga Inc for any damages, personal or financial, from any possible contraction of Covid-19. If I should contract Covid-19 or be near someone who is positive, I will not participate in live classes at the studio Free Spirits Yoga Sayville owned by Fs Yoga Inc. I agree to wear a mask at all times and will properly disinfect myself, mats and props to my best ability. I hereby affirm that I am aware that the activities I may undertake in connection with the yoga exercises, classes and/or instruction at _Free Spirits Yoga Sayville, owned by Fs Yoga Inc, including but not limited to the use of the Dharma Yoga Wheel (collectively the “Yoga Activities”) and Aerial Yoga hammocks have inherent risks which could result in serious injury. I understand that the instruction and information provided during the Yoga Activities is not intended to prevent, diagnose or treat any medical condition or disease. I also understand that engaging in any exercise regimen involves the risk of injury. I understand and agree that neither Fs Yoga Inc, nor any of their respective affiliated entities, nor any of their respective employees, instructors, officers, agents, contractors or assigns (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any personal injury, death or other damages to me, my family, estate, heirs or assigns that may occur during or in connection with the Yoga Activities or as a result of the negligence of any party, including the Released Parties, whether passive or active. I have consulted with my physician or health care professional before starting the Yoga Activities to determine that it is right for my needs. I understand that the risks associated with beginning this exercise regimen may be increased if I have a history of high blood pressure or heart disease, or if I have experienced chest pain when exercising or have experienced chest pain in the past month when not engaged in physical activity, smoke, have high cholesterol, am obese, or have a bone or joint problem that could be made worse by a change in physical activity. I represent and warrant that my physician has not advised against beginning this exercise regimen. I agree that if I experience faintness, dizziness, pain or shortness of breath at any time while exercising, I shall stop immediately and consult my physician. In consideration of being allowed to attend the Yoga Activities, I hereby personally assume all risks of the Yoga Activities whether foreseen or unforeseen, that may befall me during the Yoga Activities. I further release, exempt, covenant not to sue and hold harmless the Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of the Yoga Activities. I further state that I am at least 18 years old and of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian (as provided for below). I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this agreement. The remainder of this agreement will then be construed as though the unenforceable provision had never been contained herein. I hereby agree to defend, indemnify and hold harmless and to voluntarily release, discharge, waive, covenant not to sue and relinquish any and all actions or causes of action against the Released Parties from and against any and all claims, demands, liabilities (including, but not limited to, personal injury, property damage and wrongful death) resulting in any manner from my participation in the Yoga Activities, whether caused by negligence or otherwise. I HAVE FULLY READ THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT, AND I WARRANT THAT I FULLY UNDERSTAND THE CONTENTS THEREOF. *

I agree

By clicking this check box I agree that all information I have entered is correct and I give permission to my son/daughter to attend and participate in the activities at Free Spirits Yoga on the date listed above. I hereby grant permission to Free Spirits Yoga to use photographs and/or video taken of my son/daughter in publications, news releases, online, social media and in other communications related to the mission of Free Spirits Yoga. *

I agree

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WANT TO RENT OUR SPACE? LET'S SET IT UP

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Email *

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location preference *

Sayville Miller Place Either/Both

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PERMISSION FORM

CHILD EVENT PERMISSION FORM

INFO

EMERGENCY CONTACT

AGREEMENT

WANT TO RENT OUR SPACE? LET'S SET IT UP

HAVE A QUESTION? CONTACT US NOW!