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Health Waiver & Intake

Please take a minute to fill in the following information.

First name

Last name

Pronouns (if you choose to share them)

Phone

Address

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Do you have a doctor’s permission to participate in physical activities?

Yes

About your health

Please share any injuries, chronic conditions, physical limitations, or anything else that might be relevant to our work together. The more I know, the better I can support you. This information is confidential and will only be used to help me teach you well.

If you have any concerns about whether yoga therapy or yoga classes are appropriate for you, please consult your physician before participating. I reserve the right to modify or limit your participation if I feel it is in your best interest.

Please specify anything I should know about. This could include injuries, health conditions, a trauma history, anything you think I should know before coming to class here.

How did you hear about Yoga in The Loft?

Your responsibility in class

You know your body better than anyone. Please listen to it. If something hurts, don't do it — this is a foundational principle of how I teach. Modify, rest, or let me know, and we'll find another way. You are always welcome to stop at any time.

Acknowledgement

I understand that yoga and yoga therapy involve physical movement, which carries some inherent risk of discomfort or injury. I take responsibility for my own participation and agree to communicate openly with Jennifer about anything that might affect my safety or wellbeing in class.

I release Jennifer Snowdon from liability for any injury or loss arising from my participation.

I agree to the above terms and conditions

I am signing on behalf of my child

I give you permission to email me.

Signature

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