Liability Waiver

First Name (required)

Last Name (required)

Date of Birth (required)

Email (required)

Phone Number (required)

Emergency Contact Name (required)

Emergency Contact Phone Number (required)


That I am participating in the Yoga Classes, Health Programs or Workshops offered by Cultural Society of East Bay, Inc.’s Wellness Program, during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion that may be strenuous and may cause physical injury and I am fully aware of the risks and hazards involved. I understand it is my responsibility to consult with a physician prior to and regarding my participation in the yoga classes, health programs or workshop on an ongoing basis. I acknowledge that it is my responsibility to inform the instructor(s) of any physical or mental conditions prior to the beginning of a class In consideration of being permitted to participate in Yoga Classes, Health programs or workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program. I knowingly, voluntarily, and expressly waive, in full, any claims I may have against Cultural Society of East Bay, Inc. its agents, representatives, employees, contractors, officers or owners, for injury or damages that I may sustain as a result of participating in any class or program associated with Cultural Society of East Bay, Inc., my heirs or legal representatives’ forever release waive, discharge and covenant not to sue 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.

I agree with the terms of this Liability waiver by signing below:

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Signature Date (required)