Name * Date Address * Email * Birthdate * Parent or Guardian Name (for clients under 18 yrs.)

I understand that yoga classes/yoga therapy includes, but is not limited to, participation in physical movements, yoga postures -referred to as asanas, meditation and breathing techniques as well as an opportunity for gained awareness, and relief of muscular tension. I recognize that this may require some physical exertion, and although uncommon, may cause physical injury, and I am fully aware of the risks and hazards involved.  If I experience any pain or discomfort, I will listen to my body, stop the movement, and ask for support from Kim.  

Yoga/Yoga therapy is an individual experience.  I understand that in class or sessions, I will progress at my own pace.  If at any point, I feel overexertion or fatigue I will respect my body’s limitations.  

Yoga/yoga therapy is not a substitute for medical attention, examination, diagnosis, or treatment. Yoga postures and certain breathing techniques are not recommended and are not safe under certain medical conditions. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any sessions with Kim.  

By submitting this form, I acknowledge that participation in yoga class and yoga therapy both in person and virtual exposes me to a possible risk of personal injury.  I am fully aware of this risk and hereby release Kim Palmer Yoga Therapy, LLC from any and all liability, negligence, or other claims, arising from, or in any way connected with my participation yoga/yoga therapy.  My submission further acknowledges that I shall not now, or at any time in the future, bring any legal action against Kim Palmer Yoga Therapy, LLC, and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors, and my assigns.

I have read the above release and waiver of liability and fully understand its content. I voluntarily agree to the terms and conditions stated above.