Professional Disclosure Form and Release
We are delighted that you have chosen to become a student at Refresh Yoga Center. Review and completion of the information below will assist you in getting the most out of your classes and clarify the role of the student and the teaching staff at Refresh Yoga Center. All teachers have completed a thorough professional training in yoga instruction.
I understand that yoga includes physical movements as well as provides an opportunity for relaxation, stress reduction and relief of muscular tension. I further understand that it is my responsibility to consult with my primary care provider/physician regarding my participation in yoga classes, workshops or retreats. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. I also certify that I am in good health and am able to safely participate in a yoga class. If I experience any pain or discomfort, I will listen to my body, adjust the posture, continue to breathe smoothly, and ask for support from the teacher.
Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe to practice under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I assume full responsibility for and risk of personal injury, death or property damage resulting from my participation in yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Refresh Yoga Center and any of the teaching staff at Refresh Yoga Center.
For Massage Clients, you agree to the following:
1) I give my permission to receive massage therapy.
2) I understand that therapeutic massage is not a substitute for traditional medical treatment or medications.
3) I understand that the massage therapist does not diagnose illnesses or injuries, or prescribe medications.
4) I have clearance from my physician to receive massage therapy.
5) I understand the risks associated with massage therapy include, but are not
limited to:
• Superficial bruising
• Short-term muscle soreness
• Exacerbation of undiscovered injury
I therefore release Refresh Yoga Center and the individual massage therapist from all liability concerning these injuries that may occur during the massage session.
6) I understand the importance of informing my massage therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition.
7) I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so he/she may adjust
accordingly.
8) I understand that I or the massage therapist may terminate the session at any time.
9) I have been given a chance to ask questions about the massage therapy session and my questions have been answered
10) I understand 24 Hour notice is required for massage appointment cancellations or fees will be forfeited.
11) I agree to reconfirm my scheduled appointments in the case of inclement weather.
I acknowledge that I have read and understand this document thoroughly prior to checking this box.
