Yoga

In any physical activity, risk of serious physical injury is possible. Yoga and other activity is no substitute for medical diagnosis and/or treatment. The student assumes the risk of yoga or other activity and releases the teacher(s) and Little Land & Play Grow from any liability claims.

I, [FIRST NAME], am participating in classes or workshops with Little Land & Play Grow. I am aware of the physical risks involved with exercise and understand it is my personal responsibility to consult with my doctor regarding my participation. I have no medical conditions, that I am aware of, which would prevent me from taking part in 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 understand that it is my responsibility to find a pace that suits me. I agree to the terms and conditions stated above.

Who will be participating?

Adult Adult and Children Children

Your Information

First Name *

Last Name *

Your Date of Birth *

Mobile Number *

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Messaging policy

Email Address *

Address *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Personal Health Questionnaire

How did you hear about us?*

Please check any existing or past conditions:*
High blood pressure Back/neck pain Knee pain
Low blood sugar
Low blood pressure Hip pain Anxiety/depression Glaucoma Pregnancy (current)
Other

Please list any other health concerns, injuries, allergies or medical conditions down below.

What other forms of exercise do you do?*
Yoga Meditation
Nia Dance
Running

What are your primary goals for this class?*

Child Information:

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.