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Yoga Student Release and Information Forms
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Forum Posts: 23
Member Since:
April 27, 2015
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April 13, 2010 - 3:29 pm
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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 ________________________________________


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,



Forum Posts: 12
Member Since:
April 27, 2015
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February 7, 2011 - 11:30 pm
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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.


Forum Posts: 62
Member Since:
April 27, 2015
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February 8, 2011 - 4:43 pm
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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.

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