Do you have any existing medical conditions as determined by a health care provider that may affect your ability to participate in the class? (e.g. heart or respiratory conditions). If so, please list here.

Please inform us of any other injuries, problems, or concerns with your physical abilities.

Are you pregnant? Are you pregnant? Yes No

If you answered that you are pregnant have you received consent from a health care provider consenting to your participation in yoga classes? If you answered that you are pregnant have you received consent from a health care provider consenting to your participation in yoga classes? Yes No

If you answered that you are preganant please provide the expected delivery date.

By clicking the checkbox below, you confirm that you are not aware of any health conditions that would suggest you should not participate in yoga classes. Any doubts about participating in these activities should be reviewed with, and approved by your physician. You also confirm that you will notify us should any changes arise in your physical condition at a later date. You and your executors, administrators, heirs, agents et. al agree to waive, release, discharge and promise to indemnify any claims, arising from personal injury, disability, death, property damage or property theft; and any other claims for damages now or in the future, related directly or indirectly to your participation in any class (in person or virtual) including travel to and from our site or participation in your own home. This includes damages, loss of data, software and/or hardware or any effect arising from participating in virtual (online) activities. You understand that this Consent and Waiver of Liability and any representations made by you verbally or in writing will be used against you in any proceeding in which you make any claim of any kind against Laura Kennedy/ tierce Staff. In accordance with the Good Samaritan Act you consent to receive emergency medical treatment or transport if you are injured during the class and will not hold any tierce agents responsible for the results of same. By clicking the checkbox below below you confirm that you have read, understood, and agree to all of the above. By clicking the checkbox below, you confirm that you are not aware of any health conditions that would suggest you should not participate in yoga classes. Any doubts about participating in these activities should be reviewed with, and approved by your physician. You also confirm that you will notify us should any changes arise in your physical condition at a later date. You and your executors, administrators, heirs, agents et. al agree to waive, release, discharge and promise to indemnify any claims, arising from personal injury, disability, death, property damage or property theft; and any other claims for damages now or in the future, related directly or indirectly to your participation in any class (in person or virtual) including travel to and from our site or participation in your own home. This includes damages, loss of data, software and/or hardware or any effect arising from participating in virtual (online) activities. You understand that this Consent and Waiver of Liability and any representations made by you verbally or in writing will be used against you in any proceeding in which you make any claim of any kind against Laura Kennedy/ tierce Staff. In accordance with the Good Samaritan Act you consent to receive emergency medical treatment or transport if you are injured during the class and will not hold any tierce agents responsible for the results of same. By clicking the checkbox below below you confirm that you have read, understood, and agree to all of the above. I agree.

Name

Email Address

Join the tierce community to stay up to date on events, resources and offerings. [OPTIONAL] Join the tierce community to stay up to date on events, resources and offerings. [OPTIONAL] Sign me up for the tierce newsletter!

Do you have any existing medical conditions as determined by a health care provider that may affect your ability to participate in the class? (e.g. heart or respiratory conditions). If so, please list here.

Please inform us of any other injuries, problems, or concerns with your physical abilities.

Are you pregnant? Are you pregnant? Yes No

If you answered that you are pregnant have you received consent from a health care provider consenting to your participation in yoga classes? If you answered that you are pregnant have you received consent from a health care provider consenting to your participation in yoga classes? Yes No

If you answered that you are preganant please provide the expected delivery date.

By clicking the checkbox below, you confirm that you are not aware of any health conditions that would suggest you should not participate in yoga classes. Any doubts about participating in these activities should be reviewed with, and approved by your physician. You also confirm that you will notify us should any changes arise in your physical condition at a later date. You and your executors, administrators, heirs, agents et. al agree to waive, release, discharge and promise to indemnify any claims, arising from personal injury, disability, death, property damage or property theft; and any other claims for damages now or in the future, related directly or indirectly to your participation in any class (in person or virtual) including travel to and from our site or participation in your own home. This includes damages, loss of data, software and/or hardware or any effect arising from participating in virtual (online) activities. You understand that this Consent and Waiver of Liability and any representations made by you verbally or in writing will be used against you in any proceeding in which you make any claim of any kind against Laura Kennedy/ tierce Staff. In accordance with the Good Samaritan Act you consent to receive emergency medical treatment or transport if you are injured during the class and will not hold any tierce agents responsible for the results of same. By clicking the checkbox below below you confirm that you have read, understood, and agree to all of the above. By clicking the checkbox below, you confirm that you are not aware of any health conditions that would suggest you should not participate in yoga classes. Any doubts about participating in these activities should be reviewed with, and approved by your physician. You also confirm that you will notify us should any changes arise in your physical condition at a later date. You and your executors, administrators, heirs, agents et. al agree to waive, release, discharge and promise to indemnify any claims, arising from personal injury, disability, death, property damage or property theft; and any other claims for damages now or in the future, related directly or indirectly to your participation in any class (in person or virtual) including travel to and from our site or participation in your own home. This includes damages, loss of data, software and/or hardware or any effect arising from participating in virtual (online) activities. You understand that this Consent and Waiver of Liability and any representations made by you verbally or in writing will be used against you in any proceeding in which you make any claim of any kind against Laura Kennedy/ tierce Staff. In accordance with the Good Samaritan Act you consent to receive emergency medical treatment or transport if you are injured during the class and will not hold any tierce agents responsible for the results of same. By clicking the checkbox below below you confirm that you have read, understood, and agree to all of the above. I agree.

Name

Email Address

Join the tierce community to stay up to date on events, resources and offerings. [OPTIONAL] Join the tierce community to stay up to date on events, resources and offerings. [OPTIONAL] Sign me up for the tierce newsletter!