Yoga Intake & Waiver

Breathe Out Collective — Please complete all sections before your first class.

Participant Information

Full Name *

Email Address

Date of Birth *

Phone Number *

Emergency Contact & Phone *

Participant Acknowledgment & Consent

I understand that yoga, meditation, breathwork, sound healing, mobility work, and wellness classes offered through Breathe Out Collective may involve physical movement, stretching, balance work, breath awareness, relaxation techniques, and hands-on assists. I acknowledge that participation is voluntary and that I am responsible for listening to my body and practicing within my own limits.

I confirm that all health information provided in this form is accurate and complete to the best of my knowledge.

Hands-On Assist Consent

Some classes may include optional hands-on assists, adjustments, or supportive touch. Consent is always required before any physical assistance is given. Instructors will verbally ask for permission prior to hands-on contact, and participants may decline at any time.

I consent to hands-on physical assists and adjustments by the instructor during class, and understand I may opt out at any time by communicating my preference.

Pregnancy Acknowledgment (Optional)

If pregnant, I acknowledge that I have informed the instructor and understand I am participating at my own discretion.

Initials (if applicable)

Liability Waiver

I voluntarily participate in activities offered by Breathe Out Collective and understand that participation is at my own risk. I release and hold harmless Breathe Out Collective, its owner, instructors, facilitators, independent contractors, employees, volunteers, and affiliates from any and all liability, claims, injuries, damages, or losses arising from participation. I understand Breathe Out Collective does not diagnose medical conditions or provide medical treatment and that wellness services are not a substitute for professional medical care.

I hereby release, waive, and discharge Breathe Out Collective, its owner, instructors, contractors, and representatives from any and all liability, claims, demands, or causes of action arising out of my participation in yoga or wellness activities, whether caused by negligence or otherwise. I understand that yoga and movement practices carry inherent risks including physical injury, and I voluntarily assume all such risks.

Photo, Video & Social Media Release

Photos and videos may be captured during classes, workshops, and events for social media, website, and promotional use.

I understand that Breathe Out Collective may photograph or video-record classes and events for promotional or educational purposes. I grant permission for my image or likeness to be used in such materials, unless I have notified the studio otherwise in writing.

Studio Guidelines

Arrive on time; doors may lock after class begins
Respect the space, instructors, and fellow participants
Silence your phone and minimize disruptions
Clean and return any props used
Participate in a way that honors your body and others

I agree to abide by the studio's community guidelines, including treating all participants and staff with respect, arriving on time, silencing devices during class, and maintaining the cleanliness of the space.

Minor Participant Policy (Optional)

Ages 16–18 may attend without a parent only with a signed minor consent form
Ages 15 and under must be accompanied by a parent/guardian unless approved
Children under 10 are considered on a case-by-case basis

I acknowledge the studio's minor policy: participants under the age of 18 must have a parent or legal guardian sign this waiver. The guardian accepts full responsibility for the minor's participation and safety. (Optional)

Signature

Participant Name (Printed) *

Participant Signature (type full name) *

Date

If Participant is Under 18 (Optional)

Parent/Guardian Name

Parent/Guardian Signature