Client Waiver Form

New clients, please complete my waiver form below.

Name

If completing this form for a minor (under 19 years old), please use your child's name and information below. You'll sign your own name at the bottom of this form.

First Name

Last Name

Phone

Country

(###)

###

####

Current Age

Birth Date

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

Please share the name and phone number of a trusted emergency contact.

Terms (please read and agree)

To "Luisa F. Correa Quezada,” and her respective employees, agents, volunteers, contractors, heirs, executors, trustees, next of kin, representatives, successors, administrators and assigns (hereinafter called “instructor/practitioner”). In this Agreement (below), the term “Property” shall mean the land and premises and other structures and improvements situated at the specific event/class location. In this Agreement (below), the term “Yoga class or Reiki sessions” shall include all activities, events or services, including without limitation, yoga exercises provided, arranged, organized or conducted by the Instructor either on the Property or at other locations.

I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT.

Assumption of Risk (please read and agree):

I am aware that participating in a class or using or being on the Property involves risks, dangers and hazards including but not limited to: physical exertion which may be strenuous and cause physical injury or death; malfunction of equipment; changes or variation of terrain; slips and falls; failure of buildings or other improvements, failure to act safely or with one’s own ability; negligence of other persons; and negligence on the part of the instructor. I understand that negligence includes the failure on the part of the instructor to safeguard or protect me from the risks, dangers and hazards of being in the property and of participating in a class, whether on the property or elsewhere. I FREELY ACCEPT AND FULLY ASUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE AND LOSS RESULTING THEREFROM. I FULLY UNDERSTAND THAT PRIOR TO PARTICIPATING IN CLASSES, IT MY RESPONSIBILITY to consult a physician regarding the suitability of such participation. RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of the instructor permitting me to participate in the class whether or the Property or elsewhere, I hereby agree as follow: 1-TO WAVE ANY AND ALL CLAIMS that I have or may in the future have against the INSTRUCTOR and to RELEASE the INSTRUCTOR from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer resulting from my use of or my presence on the Property or my participation in class, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE UNDER THE OCCUPIERS LIABILITY ACT. R.S.B.C. 1996 c,337, ON THE PART OF THE INSTRUCTOR, AND ALSO INCLUDING THE FAILURE ON THE PART OF THE INSTRUCTOR TO SAFEGUARD OR PROTECT ME FROM RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE. 2-TO HOLD HARMLESS AND INDEMNIFY THE INSTRUCTOR from and against any and all claims and actions (including third party claims and actions), liabilities, damages, losses, cost and expenses of any kind ( investigating including legal and other cost and expenses incurred in investigating, negotiating, defending or settling any threatened, alleged, pending or actual claim, action or liability) in respect of death of or injury to any person, or loss of or damage to any property, howsoever caused, whether directly or indirectly relating to or arising from my participation in a Class ,OR my or my guest’s use of or presence on the property, notwithstanding that such death, injury, loss or damage may have been contributed to or caused or occasioned by the negligence or other tortious act of the instructor, I understand that negligence includes failure on the part of the instructor to take reasonable steps to safeguard or protect me from the risks, dangers and hazards of the above stated activities. Without limiting the foregoing, this indemnity shall apply to any death, injury, loss or damages to any person or property directly or indirectly arising from or alleged to arise from or relating to my participation in class or my use of or presence on the Property. 3-This Agreement shall be effective and binding upon heirs, next of kin, executors, administrators, successors, assigns and representatives, the event of my death or incapacity. 4- this Agreement and any rights, duties and obligations as between the parties to this Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia and no other jurisdiction; and 5- Any litigation involving the parties to this Agreement shall be brought solely within the Province of British Columbia and shall be within the exclusive jurisdiction of the Courts of the Province of British Columbia. I AM NOT RELYING UPON ANY ORAL OR WRITTEN REPRESENTATIONS OR STATEMENTS MADE BY THE INSTRUCTOR WITH RESPECT TO THE SAFETY OF THE PROPERTY AND PARTICIPATION IN A CLASS OTHER THAN WHAT IS SET FORTH IN THIS AGREEMENT

I CONFIRM THAT I HAVE READ AND UNDERSTAND THIS AGREEMENT PRIOR TO SIGNING IT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, SUCCESSORS, ASSIGNS AND REPRESENTATIVE MAY HAVE AGAINST THE INSTRUCTOR.

Client Signature

By typing your full name and today's date, you acknowledge that you have read, understand, and agree to the agreement content and terms noted above. *If completing this form for a minor, please type YOUR name below.