STILLNESS AND STRENGTH YOGA, LLC
Agreement of Release and Waiver of Liability: Stillness and Strength Yoga, LLC
In-Person, Remote, and Community Class Offerings
Individual and Small Group Sessions (Yoga for Survivors and TCTSY)
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Indicates required field
Name of Person Taking Class:
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First
Last
Person Taking Class: Email
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Person Taking Class: Phone
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Name of Emergency Contact for Person Taking Class:
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Phone# of Emergency Contact for Person Taking Class:
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Please read the following and ask if you have any questions.
I (participant and/or guardian) understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular as well as emotional 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. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages, which may incur through participation.
Yoga is not a substitute for medical or mental health attention, examination, diagnosis, or treatment.
Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a program. If I am pregnant, become pregnant, am post-natal, or post-surgical, my signature verifies that I have my physician's approval to participate and have been cleared for this type of movement.
I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that have now or may have hereafter against Stillness and Strength Yoga, LLC/Kristen Ryder, its owners, officers, employees, substitute teachers, and instructors.
I (participant and/or guardian) have read and fully understand and agree to the above terms of this Agreement and Release of Waiver of Liability. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Michigan.
Please review current Policies and Scope of Practice for Stillness and Strength Yoga, LLC by
clicking HERE
.
Name/Signature of Acknowledgement
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Name of participant guardian (if minor or under guardianship):
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I have reviewed SSY's "Policies & Scope of Practice" page (link above).
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Yes
Date of Signature(s)
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Submit Waiver
How to connect with mental health supports:
If you or someone you know is in immediate danger of hurting themselves or others, call 911 or go to the nearest emergency room
If you or someone your know is experiencing a mental health crisis,
dial 988
Crisis support: text "HOME" to 741741
(
www.crisistextline.org/texting-in
)
MI Warm Line: Peer mental health support specialists
:
7 days a week from 10am-2am: 1-888-733-7753
Traverse City regional crisis support via
NLCMH FAST Team
: 1-833-295-0616
Find a therapist:
www.psychologytoday.com/us/therapists
Michigan Black Therapy Fund:
https://www.miblacktherapyfund.org
LGBTQ-specific helpline:
https://www.thetrevorproject.org/get-help/
OK2SAY
(
click here for live link
): Anyone can report tips confidentially on criminal activities or potential harm directed at students, school employees, or schools. Tips can be submitted 24/7
Home
Stillness and Strength Therapeutics, PLLC
Stillness and Strength Yoga Services
TCTSY Services: What's TCTSY?
>
TCTSY Interest Form
TCTSY Consent/Waiver Form
Yoga 4 Survivors Services
>
Yoga 4 Survivors Clients
Guided Forest Therapy Sessions
SSY Policies & Scope of Practice
Schedules Descriptions Pricing Payment
Community Class Registration
Bookworms Unite! Resource Page
Meet Kristen
Contact
SSY Community Class Waiver
Home
Stillness and Strength Therapeutics, PLLC
Stillness and Strength Yoga Services
TCTSY Services: What's TCTSY?
>
TCTSY Interest Form
TCTSY Consent/Waiver Form
Yoga 4 Survivors Services
>
Yoga 4 Survivors Clients
Guided Forest Therapy Sessions
SSY Policies & Scope of Practice
Schedules Descriptions Pricing Payment
Community Class Registration
Bookworms Unite! Resource Page
Meet Kristen
Contact
SSY Community Class Waiver