1. I am willfully participating in Yoga Classes, Programs, Workshops, or Therapies offered by Surya Rakta Wellness, LLP, during which I receive information and instruction about safe practice. I recognize that these classes and workshops may require physical exertion, which may be strenuous and could result in physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in Classes, Workshops and Therapies. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in these Classes, Workshops & Therapies.

3. I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program. I agree to inform my instructor/teacher of any physical limitations, pregnancy, physical discomfort and/or injuries before and/or during classes, and I take full responsibility for nondisclosure.

4. I acknowledge that participation in Yoga classes or any other exercise class exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Surya Rakta Wellness,LLP and / or any other persons who may teach at Surya Rakta Wellness,LLP, from any and all liability, negligence, or other claims, arising from, or in any way connected, with my participation in Yoga and any other exercise class.

5. All N.S.F. cheques will be charged a $50.00 fee.

Surya Rakta Wellness • 1400 East B Street • Belleville, IL 62220
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