Yoga Waiver |

Name

First Last

Birth Date*

Phone Number*

Email Address*

Enter Email Confirm Email

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

Health Problems

Allergies
Asthma
Diabetes
Epilepsy
Heart Problems

Do you carry an Epipen?*

Yes
No

Epipen Medication Type

Do you carry an inhaler?*

Yes
No

Inhaler Medication Type

Other Medical Information:

You are responsible for ensuring that you are fit to work out before completing this form and must stop immediately if you feel any discomfort or pain.

Consent*

I understand and agree.

I understand all of the above conditions. I waive all claims against Ashbridge’s Bay Yacht Club, its employees, Directors and Members, and agree to indemnify Ashbridge’s Bay Yacht Club for any claim brought on my behalf against Ashbridge’s Bay Yacht Club.