Name of Participant
Name of Participant
Phone (mobile) of Participant &/or Parent
Phone (mobile) of Participant &/or Parent
Date of Birth of Participant
Date of Birth of Participant
check box if participant is under 18yrs of age
Name of Parent
Name of Parent
Today's Date
Today's Date

Participation Readiness and Release of Liability. 


Moderate or vigorous exercise should not be a Hazard for most people, providing it is undertaken as part of a regular program, starting from low intensity and progressing gradually. However, some people will need medical evaluation before starting a program and may only be able to undertake restricted physical activity under medical supervision.

Please answer appropriately if you are representing a child, as their Guardian/Parent.

question yourself with the following:

Has your doctor ever said that you have a heart condition AND that you should only do physical activities recommended by a doctor?

Do you feel pain in your chest when you do a physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem (i.e. back, knee or hip) that could be made worse by a change in your physical activity?

Is your doctor currently prescribing drugs (e.g. water pills) for your blood pressure or heart condition?

Are you pregnant?

Are you aged over 50?

Do you know of any reason (e.g. other medical condition) why you should not do physical activity?

If you answered NO honestly to all the questions, it is reasonable for you to assume that you are in a suitable physical condition to start a regular graduated exercise program.

If you answered YES to one or more questions, you are advised to consult your doctor PRIOR to participating in any exercise program.

By checking the box in the form, you are SIGNING that you have read, understood and completed the above questions.



Read carefully - this affects your legal rights

In exchange for participating in the movement program organized by seek yoga, and/or use of the property, facilities, equipment and services of seek yoga, i agree for myself to the following:

1. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions of directions given by the owner, agents or representatives of seek yoga.

2. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself, and further release and discharge seek yoga for injury, loss or damage arising from my use of or presence upon the property and facilities of seek yoga, whether caused by the fault of myself, Seek yoga, or other third parties.

3. I agree to indemnify and defend seek yoga Angst all claims, causes of actions, damages, judgements, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my use of or presence upon the equipment or facilities seek yoga.

4. I agree to pay for all damages to the property of seek yoga caused by my negligent, reckless or willful actions.

5. You accept that seek yoga reserves the right to refuse your participation in our activities, and/or using our facilities.

6. Any legal or equitable claim that may arise from my participation in a seek yoga Movement program organized by victoria vilaivan, seek yoga shall be resolved under canadian law.

I have read this document and understand it. I further understand that by signing this release, I voluntarily surrender certain legal rights.


**we are in Agreement that you have read the above by checking the box in the form**