Consent & Liability Waiver

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Physical Activity Readiness Questionnaire – PARQ

If you are between the ages of 18 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor prior.  Common sense is your best guide when answering these questions.

Please read carefully and answer each one honestly circling ‘YES or NO’.

    NoYes
    NoYes
    NoYes
    NoYes
    NoYes
    NoYes
    NoYes

    Yes to one or more questions: You should consult with your doctor to clarify that it is safe for you to become physically active at this present time and in your current state of health. No to all questions: You can be reasonably sure that it is safe for you to participate in physical activity, gradually building up from your current level of ability. A full fitness appraisal can help to determine your fitness level.

    Informed Consent and Liability Waiver Release for Participation in YOGA JUNKIE Ashtanga vinyasa yoga

    I am voluntarily participating in the Ashtanga vinyasa yoga modified primary series yoga class conducted by Debbie Robinson. I recognize that the class requires physical energy that may be demanding at times and may cause physical injury and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and concerning my partaking in the aforementioned sessions. I represent and warrant that I have no medical condition that would inhibit participation in the class. I agree to assume full responsibility for any risks, injuries or damage known or unknown to me, for which I may incur as a result of participating in the class. Such injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to feet, ligaments or joints, or any other illness or soreness, including death. I knowingly, voluntarily and expressly waive any claim I may have against Yoga Junkie or Debbie Robinson for injury or damages that I may sustain as a result of participating in the sessions. I have read the above waiver and release of liability and fully understand the contents. I voluntarily agree to the terms and conditions as stated above.

    I consent to the occasional and reasonable use of photography during classes, and subsequent use of these materials for the purposes of social media.

    “I have read, understood, accurately and honestly, completed this questionnaire and confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.”

    By Submitting this form I aggree to the details stipulated above

    *Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the 7 questions.  It is your responsibility to keep information updated.