QUESTIONNAIRE + AGREEMENT Name * First Name Last Name Email * Phone * (###) ### #### Emergency Contact NAME, PHONE NUMER, AND RELATIONSIP (###) ### #### Why have you chosen to enter our program at this time of your life? How long have you practiced yoga? What is your yoga history, experience, styles practiced & previous training? How has your yoga practice personally affected your life? Do you have any physical or emotional needs that we should be aware of? Anything else that you wish to mention? Thank you! TRAINING AGREEMENTPLEASE READ EACH STATEMENT BELOW, AND CHECK EACH BOX TO INDICATE YOU ACKNOWLEDGE AND AGREE. IF YOU HAVE ANY QUESTIONS, PLEASE EMAIL US AT RENEWYOGA108@GMAIL.COM I understand that yoga includes physical movements, as well as an opportunity for relaxation, stress reduction, and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. I understand that Vinyasa Yoga is a physically challenging practice, and if I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from an instructor. I also understand that the practice of yoga is much deeper than the physical body, and that the most important part of the practice is my ability to breathe comfortably. I recognize that there is no competition encouraged in this training, including competition with my own ideas of what I think I should be able to accomplish! I will listen to my own body and take rest or modify postures with confidence any time I feel the need. I assume full responsibility for any and all physical damages that I may incur through participation in these activities. I AGREE I recognize that through the course of this program, in the studies of yoga philosophy, meditation, chanting, bodywork, sharing circles, in the physical practice of yoga, in conversations/relationships with my fellow students and teachers, and simply throughout daily life, that personal challenges may also arise. I take responsibility for participating in a course of this nature, and I will honor what arises as opportunities for growth. I will make my own decisions about how to proceed in light of any personal challenges, and will most importantly always remain compassionate and loving towards myself. I AGREE I waive my right to any reimbursement or refund from this course for any reason. I recognize that I have the right to leave the course at any time, and that my decision will be fully supported should I decide to leave the program. I also recognize that this program is non-refundable, thus I will forfeit both my certification and my financial investment in the program should I leave the course for any reason whatsoever. I also accept the terms that, if I am to leave the course and miss classes for any length of time outside allotted free times (barring health emergencies and pre-approved absence by the instructors), I will not be accepted back into the program to preserve the solidarity of the program/group unless prior approval is granted by my instructors. I AGREE I acknowledge that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. I further acknowledge that Yoga, Meditation, Yogic Philosophy and Spirituality are not substitutes for therapy, counseling, or psychiatric diagnosis, care or treatment. Yoga is not recommended and is not safe under certain medical conditions. Some poses are not healthy for some body types simply by virtue of bone structure, due to previous injuries, or many other contributing factors. By signing, I affirm that I am in good physical health and good mental health to participate in such a fitness and spiritual program. In addition, I will make the instructors aware of any medical or psychological conditions or physical limitations that may affect my participation or the rest of the group before beginning this course. 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 & engage in a program of this nature, and participation is at my own risk. I AGREE Renew Yoga is committed to maintaining a program environment free of discrimination and harassment. Discrimination and harassment based on race, religion, sexual orientation, gender/gender identity, national origin, disability, age, and sexual harassment will not be tolerated during the program or on the grounds of the retreat center. Such conduct is subject to discipline, up to and including removal from the program. I AGREE I hereby agree to irrevocably release and waive my right to bring any legal action or assert any claims against Renew Yoga, Shane Davis, and all other teachers and staff members of Renew Yoga and this training, I HAVE READ THE ABOVE DOCUMENT IN ENTIRETY, AND FULLY UNDERSTAND AND AGREE TO ALL TERMS OF THIS AGREEMENT. I AGREE TYPE SIGNATURE AND DATE Thank you!
