I authorize the collection and use of the above personal information as is required for therapeutic treatment and related

administrative purpose. I understand that all my personal information is confidential and will not be released without my signed

consent.

I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended

and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and

physical condition to participate in yoga classes offered by Spiral of Life Homestead & Wellness. In addition, I will make my yoga

instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-

natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am

responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and

waive any claims that I have now or may have hereafter against Spiral of Life Homestead & Wellness.