Samasta Wellness & Yoga
Where there is Love there is Life...Ghandhi
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      • Health Questionnaire and Waiver
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Please note to Register you need to fill out a Registration form as well as this Waiver!

    Samasta Wellness & Yoga Questionnaire and Waiver

    What interests you about yoga?

    Do any of the following health conditions apply?  If yes, please give details in the comment box below.
    Please give details of health conditions or any other conditions which may cause you concern when doing Yoga:

    You hold the ultimate responsibility for your own well-being.  If you have any doubt about your well-being always stop doing anything that causes you discomfort. Always avoid anything that causes pain or injury.  Please ask your qualified instructor for assistance in finding comfort in the activity.  This class/program is not intended to replace professional medical advice/treatment. 

    In signing this waiver, I understand that classes may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury. I agree that neither I, my heirs, assigns or legal representatives will make any claims of an kind whatsoever against Samasta Wellness & Yoga, the owners, its instructors or members for any personal injury, property damage/loss, or otherwise, caused by negligence or otherwise.  

     
    Please note:  Completing this online form is an indication of acceptance and virtual signature

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If you can imagine it, you can become it...
If you can dream it, you can become it...
William Arthur Ward