Rooted Yoga Liability Waiver and Release Form Participant Information Name(Required)Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number(Required)Email(Required) Emergency Contact NameEmergency Contact PhoneWaiver and Release of Liability I, the undersigned, understand that participation in yoga classes, workshops, and activities at Rooted Yoga Studios involves physical exertion and carries the risk of injury. I acknowledge that I am voluntarily participating in these activities with full knowledge and acceptance of the risks involved, including but not limited to muscle strain, injury, or other physical discomforts. I understand and agree to the following: 1. Physical Condition: I represent that I am in good health and have no physical conditions that would prevent me from participating in yoga classes. If I have any concerns, I agree to consult a physician before participating. 2. Assumption of Risk: I fully assume all risks associated with participating in yoga activities, whether caused by negligence or otherwise. 3. Release of Liability: I release, discharge, and hold harmless Rooted Yoga Studios, its owners, instructors, employees, and affiliates from any claims, liabilities, damages, or injuries, including those caused by negligence, arising out of or related to my participation. 4. Consent to Instruction: I understand that instructors may offer physical adjustments to aid my practice. I consent to such adjustments but will inform the instructor if I do not wish to receive them. 5. Personal Property: I acknowledge that Rooted Yoga Studios is not responsible for any lost, stolen, or damaged personal items. 6. Medical Treatment Authorization: In the event of an emergency, I authorize Rooted Yoga Studios to obtain medical treatment for me and release them from any liability associated with this treatment. 7. Photography/Media Release (Optional): I grant permission for Rooted Yoga Studios to use any photographs or videos taken during classes for promotional purposes. I consent I do not consent Participant Agreement I have read this waiver, fully understand its terms, and signed it voluntarily. I agree that this waiver is binding upon me, my heirs, and my legal representatives.Participant Signature:Date MM slash DD slash YYYY Parent/Guardian Signature (if under 18):Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
