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Student Record Form Agreement

I understand that yoga is an exercise as well as an opportunity for relaxation, stress reduction, and relief of muscular tension.  If I experience any pain or discomfort, I will listen to my body, adjust the posture, ask for support from the teacher, and/or release from the posture completely.  I agree it is my sole responsibility to monitor each activity offered and determine whether or not it is appropriate for me to participate, and at what level.   I will listen to my own inner guidance and I will continue to breathe smoothly throughout the duration of class.  I will be kind and compassionate toward my entire being – mentally, physically, spiritually, and emotionally.


I understand and acknowledge that yoga is not a substitute for medical attention, examination, diagnosis, or treatment.  I affirm that I have stated all my known medical conditions and answered all questions honestly.  I have no physical or medical condition which to my knowledge would endanger myself or others if I participate in this class.  I agree to keep my teacher updated on my medical profile.  There shall be no liability on the yoga instructor’s part should I fail, forget, or neglect to do so.


Waiver and Release:

I hereby waive, discharge and hold harmless, promise not to sue, and do hereby indemnify the yoga instructor from any and all rights and claims including claims arising from the yoga instructor’s own negligence, which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of my participation in or association with this yoga class.


I agree for myself and my successors that the above representations are contractually binding, and not mere recitals, and that should I or my successors assert a claim in contravention of this agreement, the asserting party shall be liable for the expenses (including legal fees) incurred by the other party or parties in defending, unless the other party or parties are finally adjudged liable on such claim for willful and wanton negligence.  This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein, or as a consent to any other provision herein, or as a consent to any subsequent waiver or modification.

@ Copyright by Holistic Pathways LLC A Yoga & Healing Center.  Not to be copied in part or whole without sole permission from

Amanda Curtis Kezal.

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