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Intake and Waiver of Liability Form

This intake form only needs to be completed once per student and will be retained on file through the student's Yene Yoga account. Questions marked with an asterisk (*) are required for booking; while other questions are optional, responses are strongly encouraged.

Are you currently pregnant?
Yes
No
Prefer Not to Say
One a scale from 1-10, with 1 being the least and 10 being the most stressed, please rate your current level of stress.
How did you hear about us?

By signing this document, I acknowledge that I do not have any physical or mental conditions that might preclude my participation in the Activities (yoga class) provided by the Teacher (Elisabeth Woldeyohannes) and that it is my responsibility to consult with a physician before undertaking the Activities if such conditions exist; that Yene Yoga LLC is not a medical provider and that I assume full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the practice; that I knowingly and voluntarily waive and release any claim to damage or liability I may have against the Teacher, the Teacher's assistants, or the studio owner, past, present, and future, relating to the services provided; that I agree to indemnify and hold harmless Yene Yoga LLC from any loss, cost, or liability incurred in defending any claim made by me or anyone making a claim on my behalf, even if the claim is alleged to or did result from the negligence of the Released Party or anyone else; and that I have carefully read this agreement, fully understand its contents, and voluntarily and knowingly agree to the terms and conditions stated herein.

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