567 Southbridge Street  Auburn, MA  01501   (508) 832 9642  samgoldm@gmail.com                                     login

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Studio Liability Release
Bikram Yoga Sam Goldman, LLC

Health and Fitness Liability Waiver and Informed Consent Form

I have enrolled in the Hot Yoga program offered by Bikram Yoga Sam Goldman, LLC a Massachusetts Limited Liability Company (“Hot Yoga

Auburn”). In consideration of my participation as a student at Hot Yoga

Auburn I hereby consent and agree to the following:

1. I have voluntarily come to and will practice yoga as rendered and according to the theories, concepts, practices as practiced and taught by Hot Yoga Auburn. I understand, acknowledge and agree that Hot Yoga

is different than other forms of yoga and accept full personal responsibility and assume all risk associated with Hot Yoga.

2. I know that Bikram as taught by Hot Yoga Auburn involves the entire body, is offered in

a hot environment, and that it can be strenuous and intense. Having taken this into consideration, I

hereby represent to Hot Yoga Auburn that I am in good physical and mental health,

medical condition, and overall fitness. I have no pre-existing condition, nor any knowledge or reason

to know that Hot Yoga Auburn should not accept my enrollment.

3. It is my responsibility to obtain timely, regular, and current approval from health and medical personnel.

Likewise it is my responsibility to withdraw immediately should it be necessary or desirable.

4. In order to practice Bikram as a student with Hot Yoga Auburn, I will accept and follow

without question all instructions given to me including those about performing the postures. I

am aware that any deviation from the routines may put me at risk and I fully and completely accept all consequences arising directly or indirectly therewith.

5. Additionally, I am aware that nutrition, sleep and hydration is critical. I will have water or another

beverage with me at all times. If at any time or moment, including during a Hot Yoga Auburn, I feel the need to rest or to cease yoga and leave the studio then I will do so

immediately.

6. I, together with my heirs successors and assigns, hereby fully and forever release, discharge, indemnify, and hold harmless Bikram and Bikram Yoga Sam Goldman, LLC together with its instructors, agents, employees, or other persons from any and all liability,

claim, cause, damage, and/or the like.

Waivers cannot be signed by minors. Activity participants under 18 must have a waiver signed by a parent

or legal guardian to be allowed to participate in this yoga class. It is preferred that the parent or guardian

also be in attendance for the minor’s first class.

I HAVE READ THE ABOVE AND FULLY UNDERSTAND THIS CONTRACT, RELEASE AND INDEMNITY.

Print Name: ___________________________________________________________

First Middle Last

Signature: ______________________________________________ Date: ______________

Email: ______________________ Phone: ________________ Zip Code: ________

____________________________________________________________________________

Signature of parent or guardian if under 18 years of age