Liability Waiver
Welcome to SoulFire Collective!
New Student Information:
Name:___________________________________________________________
Address: _________________________________________________________
City: ____________________State: ______ Zip Code: ____________________
Primary Phone: ____________________________________________________
E-mail: __________________________________________________________
Emergency Contact Name:___________________________________________
Emergency Contact Phone:___________________________________________
Date of Birth:_______________Today’s Date:____________________________
Waiver of Liability & Disclosure Form I understand there is an inherent risk associated with any exercise program including my voluntary participation in yoga that may result in injury. I understand and am aware that the components of exercise/yoga are potentially hazardous activities and may cause injury.
1. I acknowledge that I have either had a physical examination and/or have been given permission from my physician to participate in a yoga based exercise program or that I have decided to participate in an exercise program voluntarily and without the approval of my physician and do hereby assume all responsibility for my participation in any exercise/yoga or activity associated with SoulFire Collective studio.
2. I certify that I am physically well and suffering from no medical problems, conditions, impairments, diseases, or any other illness that would prevent my full participation or increase my risk of injury and/or illness as a result of partaking in any exercise/yoga program or other activities or workshops.
3. I, my heirs, or legal representatives, do hereby forever waive and release SoulFire Collective, its members, teachers, agents and employees from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from my participation in any exercise/yoga activity, workshops or use of any equipment.
4. I understand that SoulFire Collective may provide an area for personal belongings to be held during class, however, I agree that SoulFire Collective is in no way responsible for the loss or damage of my belongings while I attend any programs, classes or workshops.
5. I acknowledge that I have read this waiver of liability form. I fully understand its terms and conditions, and understand that I am waiving and giving up my right to sue SoulFire Collective, its teachers, members, agents and employees. I acknowledge that I am signing this agreement voluntarily, and intend by my signature for this to be a complete and unconditional release of liability to the greatest extent allowable by law.
THE SOULFIRE COLLECTIVE PHOTO RELEASE FORM
I hereby grant the SoulFire Collective permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
I understand and agree that all photos will become the property of the SoulFire Collective and will not be returned.
I hereby irrevocably authorize the SoulFire Collective to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge the SoulFire Collective from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Signature____________________________________Date________________
If participant is under 18:
As legal guardian of __________________________________________, I consent to the above terms and conditions
Signature of parent/guardian ___________________________________________Date_________________
YOU, THE BUYER, MAY CANCEL THIS CONTRACT AT ANY TIME.
IF YOU WISH TO CANCEL THIS CONTRACT, YOU MAY DO SO WITHOUT ANY PENALTY OR OBLIGATION OR NOTICE. IF YOU WISH TO CANCEL BY WRITTEN NOTICE PLEASE SEND AN EMAIL
TO ________________________________ (Soul Fire Yoga LLC) AT ________________________________________________________________ (INFO@SOULFIRECOLLECTIVE.COM)
AT ANY TIME.
YOU MAY ALSO CANCEL THIS CONTRACT IF THIS SPA MOVES OR GOES OUT OF BUSINESS AND FAILS TO PROVIDE EQUAL FACILITIES WITHIN 15 MILES OF THE LOCATION DESIGNATED IN THIS CONTRACT. IF YOU CANCEL, THE HEALTH SPA MAY RETAIN OR COLLECT A PORTION OF THE CONTRACT PRICE EQUAL TO THE PROPORTIONATE VALUE OF THE SERVICES OR USE OF FACILITIES YOU HAVE ALREADY RECEIVED.”
NOTICE ANY HOLDER OF THIS CONTRACT OR NOTE IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER