Using the chart below, select the side, zone and type of discomfort you’re experiencing.
Please indicate any Present (P), Past (X), or Reoccurring (C) conditions
Assumption of Risk: I recognize the possibility of potential injury that may result from participating in Yoga classes or any other classes at Aum Home Shala (“Shala”). Being fully aware of this risk, I voluntarily choose to participate in Shala programs and accept all risks associated with that participation. In consideration of being accepted as a Yoga student, I on my own behalf, and on behalf of my heirs, administrators, executors and successors, hereby forever release and covenant not to the Shala, its officers, directors, shareholders, employees, volunteers and all others associated the Shala including Melinda Atkins, from all liability for any and all damages and injuries I may suffer while under the instruction, supervisions or control the Shala. I hereby fully agree to individually provide for all present and possible future medical expenses which I may incur as a result of any injury sustained while participating at or for the Shala.
I have read and understand this acknowledgment of policies, risk and waiver of liability and I voluntarily affix my name in agreement.
Indemnification and Hold Harmless: I also agree to INDEMNIFY DEFEND AND Aum Home Shala, (“Shala”) its officers, directors, shareholders, employees, volunteers and all others associated with the Shala including Melinda Atkins HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including but not limited, attorney’s fees, arising from, or in any way related to my participation in Shala programs, classes and events, except for those arising out of the willful misconduct and/or gross negligence of the above named parties, as applicable.
I have read and understand this acknowledgment of policies, indemnification and hold harmless agreement and I voluntarily affix my name in agreement.
By attending and participating in all AUM hOMe Shala classes and events, I hereby grant my permission to AUM hOMe Shala and its officers, directors, shareholders, employees, volunteers and all others associated with AUM hOMe Shala, including Melinda Atkins, to be filmed, audiotaped, or photographed by any means, and grant full use of my likeness, voice and words without the expectation of compensation.
I have read and agree to the above.
AUM hOMe Shala is a school with a mission to train yoga teachers and yoga therapists through observation. By offering community clinics and group classes free of charge to our participants and having our trainees sit in on these sessions, we are able to give our community access to yoga’s therapeutic benefits while also facilitating deep learning for our yoga professionals. As part of this protocol, and to ensure the comfort of everyone involved, we ask for your consent to be observed during your sessions.
I understand that I will be observed by a supervisor and one to two assistants, all with their cameras on, during my sessions.
I understand that the details of my sessions will be used as a learning tool for yoga teacher and yoga therapist trainees.
