I certify that I am medically qualified to participate in this yoga class.  I have no medical or mental condition that could cause me injury or shorten my life or that of other yoga participants. I certify that I am 21 years or older.

I hereby authorize Jessica Massie or other people present to act for me according to their best judgement in any emergency requiring medical attention, including calling an ambulance for transport to nearest medical hospital.  I give permission for a physician, members of a medical emergency response unit, and/or hospital emergency room to administer necessary care for my health.

I agree that Jessica Massie, Working Yoga, Health & Wellness Geek LLC, Julie Mackin, other instructors, members, participants, and/or volunteers will not be held responsible for any accident, losses, injury or medical treatment, however caused, and agree to release all parties involved from any claim of damages that may arise as a result of, or by reason of, such a loss or accident. I agree that they are also not responsible for monitoring personal alcohol consumption or any repercussions that could arise because of that consumption.  In addition, I agree that children should not be permitted the consumption of alcohol.

I agree to inform you of any medical or special needs, or physical limitations, that I may have for consideration during classes.  Member’s safety is our utmost priority. If I believe(s) a technique, application, or person, will cause me injury I will stand aside without prejudice from any instructor, member, participant or bystander until that activity finishes.