838 State Farm RD,  Boone, NC  28607 | (828) 386 - 1172  

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Surviving Cancer Retreat Waiver & Health Info

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Participant named above agrees to the following:

1) That I am participating in yoga classes, health programs, workshops or services offered by Soul Moving Yoga during which I may receive information and instruction or other services offered pertaining to Yoga and health. I recognize that Yoga requires physical exertion, which may be strenuous and may cause physical injury and I am fully aware of the risks and hazards involved.

2) I understand that it is my responsibility to consult with a physician prior to and regarding my participation in Yoga classes, health programs, workshops, and services. I represent and warrant that I am physically fit and I have no medical conditions, which would prevent my full participation in the Yoga classes, health programs, workshops, or services.

3) In consideration of being permitted to participate or receiving services, I agree to assume full responsibilities for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the program or from receiving any services.

4) In further consideration of being permitted to participate in Yoga classes, I knowingly, voluntarily and expressly waive any claim I may have again Soul Moving Yoga for injury or damages that I may sustain as a result of participating in the program or from receiving any services.

5) I, for myself and my heirs and legal representatives, do hereby forever release, waive, discharge, and covenant not to sue Soul Moving Yoga, LLC, Boone Healing Arts Center, their owners, employees, agents and representatives from and against any claims arising out of any personal injury, damages or loss suffered or sustained as a result of participating in the programs or services provided by them, absent gross negligence or willful misconduct on their part.

Do you have any chronic conditions, injuries or illnesses we should know about? (If No, Leave Blank)

Soul Moving Yoga in accordance with the NC Department of Health & Human Services Safety

Due to sanitary and public health safety codes, we can no longer let students with contagious rashes, fevers, coughs, athletes foot, fungus, diarrhea, or other contagious illnesses attend class until healthy. We may ask you to return with a Doctor’s consent form if we feel your illness has not cleared up. Please respect and help us enforce this policy with understanding we are only trying to protect our patrons’ health by maintaining and adhering to required health code standards and laws.

Students who are under the age of 16 years old must be accompanied by an adult over the age of 18, preferably a parent or guardian, to enter any class other than a class specifically designated as a class for children. If the instructor feels the student is a distraction, disturbance, or too difficult to teach; the instructor reserves the right to not allow the young student to return to class. Any exception to this policy must be addresses with the teacher or management prior to class to avoid any embarrassing or uncomfortable situations.

By Signing Below, Participant Named Above Agrees to the Following:

1) I have read and agree to abide by the policies listed above.

2) I have read and answered with true and accurate information the questions above concerning my health.

3) I herby agree that Soul Moving Yoga shall not be held liable for any injury, loss, or damage to property belonging to me or persons in my family.