Schedule Appointment with Samamkaya Yoga Back Care & Scoliosis Collective

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
In-Studio 5-Class Gift Certificate		$130.00
Total: $130.00	Coupon:

I hereby agree to the following:

1. That I am participating in the Yoga Classes or Workshops offered by Samamkaya Yoga Back Care and Scoliosis Collective, LLC (SYBCSC) and D Wolk Enterprises, LLC (DWE) and/or any of their agent teachers, during which I will receive information/instruction about yoga. I recognize that Yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Classes of Workshops. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Yoga Classes or Workshops. In the event I have conditions or injuries, I will tell the teacher about them.

3. In consideration of being permitted to participate in the Yoga Classes or Workshops, I agree to use the studio props only under supervision and with the permission of the class teacher as directed.

4. In further consideration of being permitted to participate in the Yoga Classes or Workshops, I knowingly, voluntarily, and expressly waive any claim that I may have against SYBCSC and/or any of its agent teachers for injury or damages that I may sustain as a result of participating in the program.

5. I, my heirs, or legal representatives forever release, waive, discharge, and covenant not to sue SYBCSC and/or any of its agent teachers for any injury or death caused by their negligence or other acts.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.