Just Gentle Yoga

Gentle mindful movement for all bodies

Health Form

← Back

Thank you for filling in your health form

The information you have provided will help me make your experience a positive and safe one for you. I look forward to seeing you soon. all the best, Jefferson Guzman

Your Information

Emergency Contact Information

Yoga and Meditation Experience

Health Information

Do you have heart trouble?(required)
Do you frequently have pain around your heart or chest?(required)
Do you ever feel faint or have spells of severe dizziness?(required)
Have you ever been told your blood pressure is too high or low?(required)
Has your doctor ever told you that you have a bone or joint problem that might be made worse by exercise?(required)
Do you have any other physical conditions which would require you to proceed with caution in an exercise program?(required)

Liability

Whether complimentary or paid, by participating in activities offered by JEFFERSON GUZMAN and JUST GENTLE YOGA, in signing below, I HEREBY RELEASE AND FOREVER DISCHARGE JEFFERSON GUZMAN and JUST GENTLE YOGA and its shareholders, directors, officers, agents, servants and employees and or their successors, heirs, assigns (the Releasees) of and from all actions, causes of action and exams or every kind or nature whatsoever, however caused arising out of, or in any way described below and notwithstanding that the name may have been contributed to or occasioned by the negligence of the RELEASEES or without limiting the generality of the foregoing. I also acknowledge and understand that a risk of personal injury may be involved in the exercise. I THEREFORE AGREE TO FOLLOW INSTRUCTIONS CAREFULLY. Yoga classes, workshops, intensives, and study groups include techniques and exercises for the development of strength, flexibility, endurance, stamina, relaxation, and breath awareness. Some classes may include the use of equipment in support of the above techniques (mat, belts, pillows, bricks, benches etc.). I agree that JEFFERSON GUZMAN and JUST GENTLE YOGA is in no way responsible for the safekeeping of my personal belongings at any time. I understand that JEFFERSON GUZMAN and JUST GENTLE YOGA classes may be physically strenuous and I voluntarily participate in them with the full knowledge that there is a risk of personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.