Waiver Receipt
Yoga • Breathwork • Meditation
- Participant
- Date
- Phone
- Signature
- Guardian Name
- Guardian Signature
- Media Consent
- Submitter IP
- Submission Timestamp
Waiver
Fill out the below waiver
Yoga, Breathwork & Meditation Waiver
Instructor: Mireille Stettler (Independent Yoga Instructor)
Location: CMAC Dojo, Mississauga, Ontario
Acknowledgment & Assumption of Risk
I understand that yoga, breathwork, and meditation involve physical and mental activity, and that participation carries risks, including potential injury, discomfort, or emotional distress. I acknowledge that I am participating voluntarily, at my own risk, and that I am responsible for listening to my body and modifying or stopping any activity that causes pain or discomfort. If I am pregnant, recently injured, or have a medical condition, I have consulted my healthcare provider prior to participating.
Release of Liability
In consideration of being allowed to participate in classes or events offered by Mireille Stettler, I hereby release and discharge Mireille Stettler, CMAC Dojo, and their owners, instructors, officers, agents, employees, contractors, and affiliates from any and all liability, claims, or demands arising from my participation, including injury or loss that may result from negligence.
Indemnification
I agree to indemnify and hold harmless Mireille Stettler and CMAC Dojo from any loss, damage, or costs arising from my participation in these classes.
Health Disclaimer
I understand that yoga and breathwork are not substitutes for medical care and that I am responsible for my own well-being throughout class.
Media Consent
Media Consent
Minors (Ages 12–17)
A parent or legal guardian must sign this form on behalf of any participant under 18 years of age.