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Please fill out the following form in order to participate in our meditation and yoga classes & events

Have you been hospitalized or given birth in the last 12 months?
Are you suffering from a medical condition, illness, or injury?
Please read & sign

I will make the teacher aware of any medical conditions or physical limitations before our sessions. 


Yoga & Meditation are not a substitute for medical attention, examination, diagnosis or treatment. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. 


If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the teacher. 


I understand my yoga instructor can suppor me to omit or adapt all movements and stretches so that I am not in physical pain. Classes can also be adapted to a chair. Additionally, if I experience extremely challenging thoughts or mental processes during guided meditation, I understand I can stop and also ask for support. I recognize that I may be invited to do physical movement during meditation classes, such as sitting, standing and walking meditation. 


I affirm that I alone am responsible to decide whether to practice yoga and meditation and participation is at my own risk. 


I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reeducation and relief of muscular 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.


I am approved by a medical professional for physical activity.


If I am pregnant, become pregnant or I am post-natal or post- surgical, my signature verifies that I have my physician’s approval to participate.


I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against EarthWell Retreat Center, LLC owners, staff and contracted teachers.

Thanks for submitting!

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