Name

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Date (mm/dd/yyyy)

I have read the above limitations, and none apply to me or I have received medical clearance from my physician for any condition above that may apply to me.
—Please choose an option—Yes

I am not aware of any medical problem that I might have which may interfere with my taking of classes at Raffa Yoga Inc facility and/or make it unsafe to participate in classes offered.
—Please choose an option—Yes

I understand that Raffa Yoga Inc reserves the right to refuse participation.
—Please choose an option—Yes

I understand that any teacher providing classes to me at Raffa Yoga is not a physician and cannot diagnose or suggest remedies for any medical condition or disease.
—Please choose an option—Yes

I understand that it is my responsibility to notify my teacher of any medical or health limitations I may have and to notify my teacher if I am ever in discomfort or pain.
—Please choose an option—Yes

I hereby release and hold Urban Sweat, Christine Raffa, CMR Enterprises, LLC, Raffa Yoga, Inc., and any teacher from whom I take class with
wear and tear due to my participation of class and the facility I may use therein
—Please choose an option—Yes

Verification
7+1=?

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