Balanced a HOT Yoga Studio Release Form
I am aware that an exercise program like the one that I am enrolling at Balanced a HOT Yoga
Studio carries with it by nature certain dangers. I understand that by signing below I assume the
full risk of any injury inherent in a yoga or exercise program. I further state that I am physically fit
and that I hereby release and hold Balanced a HOT Yoga Studio, its officers, directors, agents,
and subcontractors, instructors, and all other individuals in any way associated with Balanced a
HOT Yoga Studio and/or any of the programs offered at or by Balanced a HOT Yoga Studio
harmless from all claims of any kind whatsoever that I may now or at any time in the future have
for damages or injuries arising out of my attendance and/or participation in said program, event,
If I have now or in the past been treated or diagnosed with, or am currently under medical care
and/or supervision for any disorder that could put me at risk of injury or death from the type of
program I will be participating in at Balanced a HOT Yoga Studio, whether, for example, but not
by way of limitation, said disorder is high blood pressure, a heart condition, history of
cardiovascular disorder, neck, shoulder, back, knee, or other medical issue, I have checked off
the box below and have at the same time delivered a written statement from my treating
physician or other duly licensed and qualified medical professional stating that I am fit to
participate in the proposed class. I hereby agree to immediately inform my instructor at
Balanced a HOT Yoga Studio of any change in my physical condition.
Please Print Clearly
Do you have any Injuries or Medical Issues? If so please state
How did you hear about us?
I have medical issues and have delivered a medical certification.