Liability Waiver Form

DISCLAIMER

The Clumsy Yogi, LLC recommends that you consult your physician regarding the applicability of any recommendations and follow all safety instructions before beginning any exercise program. When participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, and assume all risk of injury to yourself.

First name

Last name

Date of birth

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness or injury?

Yes

If you answered yes to any of the questions above, please supply additional information.

I declare that the info I’ve provided is accurate and complete.

Signature