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 Yoga By Victoria Agreement of Release & Waiver of Liability

It is your responsibility to notify and inform Victoria of any limitations before the session begins.

Please read the following and ask if you have any questions.

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I understand that personal training and yoga include physical movements as well as an opportunity for relaxation, stress 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 eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor.

I assume full responsibility for any and all damages, which may incur through participation. I acknowledge personal training and/or yoga is/are not a substitute for medical attention, examination, diagnosis, or treatment. Personal training and/or yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before the session begins. 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 also affirm that I alone am responsible to decide whether to perform physical activity or practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Victoria Koopman.  

I wish to participate in the exercise and training program offered by Yoga By Victoria. I understand there are inherent risks in participating in a program of strenuous exercise; consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program within sixty (60) days of the date set forth. No change has occurred in my physical condition since the date such approval was given which might affect my ability to participate in the fitness program. If a physician has not examined me, I agree to see a physician within sixty (60) days of the date set forth below to obtain his/her approval for my participation in a fitness program. If I choose not to see a physician prior to beginning a fitness program, I do so strictly at my own risk. I also agree to provide Yoga By Victoria with my physician’s contact information so that Yoga By Victoria may receive direct clearance and program recommendations/limitations from my physician. I further agree that Yoga By Victoria shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, outdoors or in any fitness facility), and I expressly release and discharge Yoga By Victoria from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only and injury caused by an intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators, and assigns.

I understand that Yoga By Victoria will make every reasonable effort to preserve the privacy of the information contained in this Intake Form. I further agree that Yoga By Victoria shall not be liable or responsible to me for any inadvertent disclosure of the information contained in the Intake Form and I expressly release and discharge Yoga By Victoria from all claims, actions, judgment and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any damage which may occur in connection with disclosure of private information contained in the Intake Form. This release shall be binding upon my heirs, executors, administrators and assigns.

I certify that the answers to the questions outlined on the PAR-Q from are true and complete to the best of my knowledge. I acknowledge that medical clearance is requested if I have answered “Yes” to any of the questions on the PAR-Q form. I understand and agree that it is my responsibility to inform Olivia Fisher of any condition or changes in my health, now and on going, which might affect my ability to exercise safely and with minimal risk of injury.

I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participations at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform Yoga By Victoria.

I understand that the results of any fitness program cannot be guaranteed and my progress depends on my effort and cooperation in and outside of the sessions.

I have read and fully understand and agree to the above terms of this Agreement and Release of Waiver of Liability. I am signing this agreement voluntarily and recognize that my signature serves as a complete and unconditional release of all liability to the greatest extent allowed by law in the State of Oregon.