Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Medical/Physical Declaration:

Are you suffering or have you in the last 5 years suffered from any of the following? Please check all which apply to you.

Asthma/Bronchitis

Diabetes

Any Heart Conditions

Allergies (to medications, nuts, bites/stings...)

Fit, Fainting, Blackouts

Severe Headaches

High blood pressure, hypertension

Circulatory disturbance, e.g. varicose veins, leg swelling, cold extremities, etc.

Breathing difficulties: breathlessness, cough, wheezing, pain on breathing, etc.

Muscular weakness; disturbance of balance or co-ordination; tremor

Other illnesses/disabilities/conditions we should know about

Pregnancy

I can swim 25m unassisted *

Yes

No

I am physically well and fit *

Yes

No

I confirm that the above information is correct and if any information changes I will notify the instructor/company, including poor/under par health on the day of activity. *

I certify that to the best of my knowledge, I do not suffer from a medical condition which might have the effect of making it more likely that I be involved in an accident which could result in injury to myself or others. *

Disclaimer *

I, the undersigned, being aware of my own health and physical condition and having knowledge that my participation in any SUP Yoga Classes, Yoga Classes, Workshops and Retreats may be injurious to my health, am voluntarily participating in the SUP Yoga Classes, Yoga Classes, Workshops and Retreats with Isis du Jour Yoga | SUP Yoga Sussex. I understand and accept that misuse of any equipment is likely to result in serious personal injury to others and/or myself. I understand that while company staff and instructors will take all reasonable care of the participants and unless they are negligent they cannot be held responsible for any loss, damage or injury suffered arising during the activity attended. Having such knowledge, I hereby release Isis du Jour (Isis du Jour Yoga | SUP Yoga Sussex) from any liability for accidental injury or illness, which I may incur because of participating in the said SUP Yoga Classes, Yoga Classes, Workshops and Retreats. I hereby assume all risks connected therewith and consent to participate in the said SUP Yoga Classes, Yoga Classes, Workshops and Retreats. I agree to disclose any physical limitations, disabilities, ailments or impairments, which may affect my ability to participate in the said SUP Yoga Classes, Yoga Classes, Workshops and Retreats With regards to all forms of exercise if you have any doubt about your level of health and fitness it is advisable to consult your GP prior to the commencement of any new fitness plan. The instructor must be informed of any injuries, handicaps or medical problems prior to joining the SUP Yoga Classes, Yoga Classes, Workshops and Retreats. Isis du Jour (Isis du Jour Yoga | SUP Yoga Sussex) cannot accept responsibility for personal injury whilst participating in the SUP Yoga Classes, Yoga Classes, Workshops and Retreats.

I agree, and I acknowledge that I exercise at my own risk

Waver of Liability (Please read carefully) *

I hereby agree to the following: I agree and acknowledge that I am fully aware that participation in this activity may involve risks and I accept all the risks of participating. I will progress at my own pace and I understand my physical limitations, so I am sufficiently self-aware to stop physical activity before I become ill or injured. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the SUP Yoga Classes, Yoga Classes, Workshops and Retreats. In consideration of being permitted to participate in the SUP Yoga Classes, Yoga Classes, Workshops and Retreats, I knowingly, voluntarily, and expressly waive any claim I may have against Isis du Jour Yoga | SUP Yoga Sussex for injuries or damages that I may sustain as a result in participating in the SUP Yoga Classes, Yoga Classes, Workshops and Retreats. My agreement acknowledges that I shall not now, or at any time in the future, bring any legal action against Isis du Jour Yoga | SUP Yoga Sussex, Isis du Jour, and/or any other person who may teach at Isis du Jour Yoga | SUP Yoga Sussex; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors, and my assigns. My agreement verifies that I am participating in SUP Yoga and Yoga at Isis du Jour Yoga | SUP Yoga Sussex with my doctor’s full approval. If you are under 18, you must have a parent’s agreement. My agreement is binding to this liability waiver from this day forth.

I agree

Name *

First Name

Last Name

Signed Date *

MM

DD

YYYY

I understand that I may be contacted by email with relevant news and updates. Please indicate by ticking the box if you DO NOT wish to receive occasional email communications.

Please note that photographs may be taken during the activity and may be used for publicity and marketing purposes. Please indicate by ticking the box if you DO NOT wish to have your photograph taken/used.