Yoga & Mindfulness Waiver

Agreement of Release and Waiver of Liability
Stillness and Strength Yoga, LLC
In-Person and Remote Offerings for:
Yoga, Mindfulness, General Wellness, Yoga for Survivors, and TCTSY*
(not Forestbathing; click here* for Forestbathing Waiver)

* Indicates required field

Name of Person Taking Class: *

First

Last

Person Taking Class: Email *

Person Taking Class: Phone *

Name of Emergency Contact for Person Taking Class: *

Phone# of Emergency Contact for Person Taking Class: *

Please read the following and ask if you have any questions.

I (participant and/or guardian) understand that Stillness and Strength Yoga LLC's offerings include physical movements as well as an opportunity/potential 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 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 and mindfulness are not substitutes for medical or mental health attention, examination, diagnosis, or treatment. These services are not recommended and are not safe under certain medical conditions. By signing, I affirm that a licensed physician/medical/mental health care provider has verified my health and condition to participate in such a program/event. 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 join/practice, and participation is at my own risk. I hereby agree to irrevocably release, hold harmless, indemnify, and waive any claims that I have now or may have hereafter against Stillness and Strength Therapeutics, PLLC/Kristen Ryder, its owner, substitute teachers, and any assigned heirs.

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 *

Name of participant guardian (if minor or under guardianship): *

I have reviewed SSY's "Policies & Scope of Practice" page (link above). *

Yes

Date of Signature(s) *

Submit Waiver

How to connect with mental health supports:

MI Warm Line: Peer mental health support specialists: 7 days a week 10am-2am: 1-888-733-7753
LGBTQ-specific helpline: https://www.thetrevorproject.org/get-help/
In a mental health crisis (you or someone else): dial or text 988
In need of crisis support: text "HOME" to 741741 (www.crisistextline.org/texting-in)
Traverse City regional crisis support via NLCMH FAST Team: 1-833-295-0616
Munson Intensive Outpatient/Partial Hospitalization Program: Call 231-935-6880 or Click HERE
PineRest Psychiatric Urgent Care Grand Rapids: Click Here or dial 616-455-9200
If you or someone you know is in immediate danger of hurting themselves or others, call 911 or go to the nearest emergency room
Find a therapist: www.psychologytoday.com/us/therapists
Michigan Black Therapy Fund: https://www.miblacktherapyfund.org
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

Agreement of Release and Waiver of LiabilityStillness and Strength Yoga, LLCIn-Person and Remote Offerings for:Yoga, Mindfulness, General Wellness, Yoga for Survivors, and TCTSY*(*not Forestbathing; click here for Forestbathing Waiver)

Agreement of Release and Waiver of Liability
Stillness and Strength Yoga, LLC
In-Person and Remote Offerings for:
Yoga, Mindfulness, General Wellness, Yoga for Survivors, and TCTSY*
(not Forestbathing; click here* for Forestbathing Waiver)