Karma Garden, LLC - Professional Disclosure Form and Release
(please bring to class)

Name:__________________________________________________________________________________

Full Address:_____________________________________________________________________________

Phone: (Daytime)________________________________ (Evening)_________________________________

E-mail (home and work):____________________________________________________________________

General Health Condition (Please list any illness or recent injury - use separate paper if needed.):

Have you previously taken yoga (if yes, please state for how long and how long ago)?

The following information will help you get the most out of your yoga classes. Please read and sign below.

1. All exercise programs involve risk of injury. By choosing to participate in yoga classes, you voluntarily assume a certain risk of injury. The following guidelines will help you reduce this risk:

- Listen to and follow instructions carefully. Ask me if you are unsure how to perform a certain movement.
- Breathe smoothly and continuously as you move and stretch.
- Do not hold your breath or strain to attain any positions.
- Work gently, respecting your body's abilities and limits.
- Don't perform postures or movements that are painful.
- Menstruating women should not practice inverted postures.
- Pregnant women must consult their health care provider before beginning yoga.

2. It is always advisable to consult with your physician before beginning any exercise program.

3. Awareness is fundamental to the practice of Kripalu Yoga. As a student, it is solely your responsibility to monitor each activity offered and determine whether it is appropriate, and at what level it is appropriate to participate. Though I am your teacher, you remain primarily responsible for your safety and well being.

4. As a professional, I am responsible to provide competent yoga instruction. I am not responsible for insuring the safety of my students beyond this duty. Please practice safely.

5. By signing this form you hereby release Nancy Slyman, Karma Garden and A Healing Trail from any and all liability for injuries that are not directly and proximately caused by their professional negligence.

I have read, understood, and agree to the content of the Professional Disclosure Form and Release.

Signature _____________________________________ Date __________________