Waiver

In consideration of permitting me, _______________________________ to enroll in Therapeutic Yoga and/or Personal Training by Tina van Hamersveld through the facility of Resilient Yoga Therapeutics in the city of San Marcos in the county of San Diego and the state of California beginning on the ______ day of (month) _________________ 20______. I, for myself, my personal representatives, heirs, and next of kin:

HEREBY acknowledge that Therapeutic Yoga and Personal Training could involve the risk of injury depending upon my physical health. I understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment, is a potentially hazardous activity. I also understand that fitness activities involve the risk of injury and even death, and that I am voluntarily participating in these activities and using facilities, equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death.

HEREBY further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment or machinery except as hereinafter stated. I do hereby acknowledge that I have been informed of the need for a physician's approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise and use of exercise and training equipment so that I might have their recommendations concerning these fitness activities and equipment use. I acknowledge that I have either had a physical examination and have been given my physician's permission to participate, or that I have decided to participate in activity and use of equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities.

If I should need emergency medical treatment, and I am not able to give my consent or make my own arrangements for that treatment because of my physical or mental condition, I authorize Tina van Hamersveld to take whatever measures are necessary to protect my health and well-being, including, if necessary, hospitalization.

HEREBY RELEASE, WAIVE, DISCHARGE AND AGREE NOT TO SUE Tina van Hamersveld, Resilient Yoga Therapeutics, her facility, or any of its officers, instructors, agents, or employees (the Releasees) FROM ALL LIABILITY TO MYSELF, my personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO MY PERSON, NOW AND FOREVER, ARISING OUT OF OR RELATED TO THE PARTICIPATION AND/OR INSTRUCTION IN SAID ACTIVITIES OR ANY OTHER RELATED OPERATIONS THAT MAY OCCUR, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, now and forever, arising out of or related to participation and /or instruction in said activities or any other related operations whether foreseen or unforeseen and whether caused by negligence of the Releasees or otherwise. I HEREBY SEPARATELY agree to INDEMNIFY and SAVE and HOLD HARMLESS the Releasees from any loss, liability, damage or cost that they may incur, now and forever, arising out of or related to participation and/or instruction in said activities or any other related operations, whether caused by the negligence of the Releasees or otherwise.

HEREBY acknowledge and accept that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PRECEDURES OF THE RELEASEES and agree that this Waiver and Release of Liability and Indemnity Agreement extends to all acts of negligence by Releasees. INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as permitted by the laws of the Province or State in which the activities are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I have read this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, am aware of its legal consequences, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I have had the opportunity to personally discuss with the instructor the potential dangers incidental to engaging in the activity and related operations.

This Agreement shall be binding upon the undersigned, their heirs, executors, administrators and assigns.

Participant’s Name ____________________________             _________________________________

                                                  (Please Print)                                                                   (Signature)