I am getting started in putting together my Yoga business and I was wondering where I could find sample copies of Client release forms, and such. I remember(from classes attended in the past) having to fill out intake type of forms with health questions and liability releases. Any body have any ideas or suggestions? Thank you.
Yoga Teacher Training Forum » Yoga Teacher Training Forum (issues, concerns and questions for teachers) » Business and Marketing your Business
Yoga Student Release and Information Forms
(15 posts) (12 voices)-
Posted 3 years ago #
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Dear Luci,
Below is a sample of our release form. Feel free to modify it to suit your needs.
AURA Wellness Center
21 Park Street, Suite 202
Attleboro, MA 02703
Yoga Pilates Personal Fitness Training Tai Chi
Name: ________________________________________________________
Telephone: ______________________________________________________
Address: ______________________________________________________
City: ________________________________ State: __________________
Zip: ________________________
E-mail address: ___________________________________________________
Medical Alert (injuries, physical limitations, ailments, etc.)
_______________________________________________
_______________________________________________
_______________________________________________
How did you hear about Aura Wellness Center?
____________________________________________________
Participation in Yoga classes includes, but is not limited to, participation in meditation techniques, yogic breathing techniques, and performing various Yoga postures. Yoga postures, or asanas, are designed to exercise every part of the body - stretching and toning the muscles and joints, the spine and the entire skeletal system. They also work on the internal organs, glands and nerves. Yoga incorporates sustained stretching to strengthen muscles and increase flexibility.
Yoga and physical exercise is an individual experience. I understand that in Yoga, and in any other exercise class, I will progress at my own pace. If at any point I feel overexertion or fatigue, I will respect my own body's limitations and I will rest before continuing Yoga or any other exercise.
By signing my name below, I acknowledge that participation in Yoga classes or any other exercise class exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Aura Wellness Center, Paul Jerard, Marie Jerard, and / or any other persons who may teach at Aura Wellness Center, from any and all liability, negligence, or other claims, arising from, or in any way connected, with my participation in Yoga and any other exercise class.
My signature further acknowledges that I shall not now, or at any time in the future, bring any legal action against Aura Wellness Center, Paul Jerard, Marie Jerard and /or any other persons who may teach at Aura Wellness Center; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns.
My signature verifies that I am physically fit to participate in Yoga classes, or any other exercise classes, and a licensed medical doctor has verified my physical condition for participation in this type of class.
If I am pregnant, or become pregnant, or am post-natal, my signature verifies that I am participating in Yoga, or any other exercise classes, with my doctor's full approval.
I realize that I am participating in Yoga, or any other exercise classes, at my own risk.
My signature is binding to this liability waiver from this day forth.
Date _________________________
Signature ________________________________________
IF UNDER 18 YEARS OF AGE
As legal guardian of ________________________________, we consent to the above conditions.
Signature of Guardian: _______________________________
Informed Consent and Waiver of Liability
I understand that Yoga, Pilates, Personal Fitness Training, Tai Chi, and any other exercise program can be physically intensive, and I voluntarily assume the risk inherent in my participation in exercise classes at Aura Wellness Center, including the risk of injury, accident, death, loss, cost or damage to my person or property. I release and indemnify Aura Wellness Center from, and against, any and all such claims and liabilities, including attorneys' fees.
I further attest that I am in sufficient physical health, and/or that I have consulted with a physician and I am able to undertake and engage in the physical movements and exercises in classes that I have chosen to take at Aura Wellness Center.
I assume responsibility to update Aura Wellness Center of any changes in my medical condition that might affect my safety or participation in any classes at Aura Wellness Center.
Signature _________________________________________________
Date _______________________
Om Shanti,
PaulPosted 3 years ago # -
Thank you so much, Paul!
This is perfect! I was trying to adapt the one I use for my Reiki practice, but it just wasn't quite right. This will definetly do the job. Thanks again.
Peace,
LuciPosted 3 years ago # -
Below is another sample:
Yoga Class
Enrollment and Waiver Form
Name__________________________________________________________________________________________
Address_______________________________________________________________________________________
City_______________________ State___________________ Zip
Code__________________
Home Phone_____________________________________
Work Phone______________________________________
EMail__________________________________________________________________________________
Limitations, Injuries,
Surgeries_______________________________________________________________________
If so, date of onset, or surgery________________________________________________
Emergency
Contact__________________________________________________________________________
Release and Waiver of Liability
In any physical activity, risk of serious physical injury is possible. Yoga is no substitute
for medical diagnosis and treatment. Yoga practice and/or specific poses are not
recommended for individuals with certain conditions (e.g., cardiac illness, later stages
of pregnancy, post-surgery) The student assumes the risk of yoga practice and releases
the teacher(s) and Center for Health and Wellness from any liability claims.
I, _______________________________________________, am participating in yoga
classes, or workshops, at the Center for Health and Wellness. I am aware of the physical
risks involved with strenuous exercise and understand it is my personal responsibility
to consult with my Doctor regarding my participation. I have no medical condition,
which would prevent me from taking part in yoga classes or workshops, and I assume
responsibility for any risk or injury I may sustain as a result of my participation. I have
read the above release and waiver of liability and understand its contents. I agree to the
terms and conditions stated above.
Date___/___/___
Signature____________________________________________________Posted 3 years ago # -
Some say yoga teachers shouldn't have liability waivers. Yeah - right. One student refused and said I didn't have a yogic attitude because he had to sign forms and follow rules. So sorry, but the rules are in place to protect the many from the few.
Everyone who inquires about my yoga classes must complete a waiver form. This is a requirement for my teaching insurance! It also makes yoga teachers aware of any health conditions students have. It aids in planning yoga classes with student needs in mind.Posted 3 years ago # -
Hi Ecstar,
One point, your form states "I have no medical condition, which would prevent me from taking part in yoga classes or workshops." That might be better to say, "To the best of my knowledge I have no medical condition...." Also, does this imply that you wouldn't modify if I have back problems, High blood pressure, or heart problems? I don't mean to pick, but your form seems like it's geared toward the younger student age 18 to 30.
Sincerely,
GatorPosted 3 years ago # -
This is good info. all the way around. Thank you everyone!Posted 3 years ago #
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Seriously, rules are part of any school, university, ashram, studio or center. Bikram is right that people need a kick in the pants. I hope you kicked that student out the door. If you didn't have rules people would pull all kinds of stuff. At Bikrams yoga teacher training you learn to knock people into line. Nip it in the bud and don't put up with foolishness. A yoga college isn't a democracy. Students follow the rules or get out.Posted 3 years ago #
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Thank you Paul and Ecstar for the form samples. The tips from Luci, Gator, and Andora about liability forms for Yoga instructors are great! Thank you so much. This is something I put off for too long.
Really Heather! I love it. "Sign the form or else...." Please, please send clips of your Bikram yoga class spanking video to Aura. Hahahaha. They can send all of us short video clips of you teaching Bikram yoga in the newsletter. You'll be famous: "Heather the Hot Spanking Yoga Diva."Posted 3 years ago # -
Namaskar!
I never thought yoga liability forms could be so exciting.
Below is another variation.
One thing: I've never ever seen a student injured in any yoga classes, but we don't spank, kick, or jump on them either.
Shanti,
Tomako
---------------------------------
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
NAME: ___________________________________________________________________________
STREET: _________________________________________________________________________
CITY: _________________________________ STATE: __________ ZIP CODE: _______________
HOME PHONE: __________________OFFICE: __________________ CELL:___________________
HOW DID YOU HEAR ABOUT US ? _________________________________________________________
E-MAIL ADDRESS :_______________________________________________________________________________
Please list any physical conditions or disabilities, current or chronic, any medication taken at this time or any allergies. This information will help the instructor modify and tailor poses for your comfort and safety.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I, ______________________________________, hereby agree to the following:
1. That I am participating in the Yoga Classes offered by Yoga School during which I will receive information and instruction about Yoga and health. I recognize that Yoga involves physical exertion which my 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 the Yoga Class. I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the Yoga Class.
3. In consideration of being permitted to participate in the Yoga Class, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.
4. In further consideration of being permitted to participate in the Yoga Class, I knowingly, voluntarily and expressly waive any claim I may have against Yoga School / Yoga Teacher for injury or damages that I may sustain as a result of participating in the program.
5. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue for any injury or death caused by their negligence or other acts.
I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
Signature _________________________________________________________________ Date ________________
As Legal Guardian of______________________________________________________, I consent to the above terms and conditions.
Signature of Parent/Legal Guardian _________________________________________Date: __________________Posted 3 years ago # -
I'm surprised by all the sharing of information here. I took a yoga teacher training course for an arm and a leg. It was fun, but I didn't learn anything about the subtle body, business, pranayama, meditation, etc. Thank God I found this site. Now I can take continuing education courses for a fraction of what my original yoga certification organization wants. They want an arm and a leg for CEUs too, so I'm going to transfer over to Aura.Posted 3 years ago #
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I really appreciate the forms for yoga liability protection.
Thank You!Posted 3 years ago # -
We are most likely the same with the format. I am also a yoga teacher in our state. It is definitely important to know the possible solution when anyone get injured or accident when you are in the training.Posted 2 years ago #
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What do you do if a person refuses to sign your form? I just had somebody last week who loudly refused to sign anything.
Posted 2 years ago # -
Sorry Classyoga, but an objection to a mutual understanding toward the goal of yoga student safety (common sense) is a red light. You have the right to refuse anyone. Students who refuse to accept warnings and don't listen should leave - Pronto. You can't teach yoga to people who are uncooperative. Stop them at the door and tell them to leave. Some people need to be protected from themselves. They can injure themselves on their own time, but not in our yoga classes.
Posted 2 years ago #
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