New Client Form


Name *
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I agree to the terms and policies of Nourishing Habits LLC , ( Signature* AGREEMENT OF RELEASE AND WAIVER OF LIABILITY AGREEMENT I, _(name above), hereby agree to the following: I have enrolled and am participating in a health and fitness program and/or Digital Wellness program with Nourishing Habits, L.L.C. (“program”), which may include yoga postures, strength training, stretching and breathing exercises. I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction and re-education 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. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for assistance and support from the instructor. I fully understand that the program may be strenuous and I choose to participate voluntarily. I fully understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment. I also understand that yoga may not be safe or recommended under certain medical conditions. I acknowledge that I have had a physical examination and that my physician has approved of my participation in the program, or that I have decided to participate in the program without the approval of a physician. I represent and warrant that I am physically well and suffering from no condition, impairment, prior injury, or disease that would prevent my participation in this program. I will advise my yoga instructor about any significant health issue or condition, including prior injuries, and pregnancy before I participate in the program. If I am pregnant, become pregnant or I am postpartum or post-surgical, my signature below verifies that I have my physician’s approval to participate in the program. I fully understand that I may receive ‘hands-on’ assistance from my yoga instructor during my participation in the program in a manner that is both safe and appropriate; I am comfortable with this aspect of the program. I affirm that I alone am responsible to decide whether to practice yoga and that participation in the program is at my own risk. I assume full responsibility for any risks, injuries or damages, known or unknown, which I may incur as a result of participating in the program. In further consideration of being permitted to participate in its program, I hereby agree to irrevocably release Nourishing Habits, L.L.C., its principals, agents, and employees, from any and all liability, claims, demands, actions or rights of action, which I may have now or in the future, and which are related to, arise out of, or are in any way connected with my participation in the program, including those allegedly attributed to the negligent acts or omissions of the before mentioned parties. This agreement of release and waiver of liability (“agreement”) shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. I have read this agreement and I fully understand its terms. I fully understand that I have given up certain rights by signing this agreement and I have signed it freely and without any inducement or assurances. I further agree that if any part of this agreement is held to be invalid, the balance of such agreement, notwithstanding, shall continue in full force and effect. I voluntarily agree to the terms and conditions stated above and recognize that my signature below serves as a complete and unconditional release of all liability to the greatest extent allowed by law in the State of Connecticut. Participant’s Signature is above. Date of Agreement (today's date is above)*