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Participant Enrollment Form 
Yoga with Rebecca Wilhelm

Please fill out completely before you participate in yoga class. 

By providing email, you agree to be on our mailing list.

Do you have any medical restrictions or conditions that I should be aware of?

I hereby consent as a participant in yoga classes and agree to assume all of the risks involved.  I understand that Rebecca Wilhelm does not provide medical insurance relative to accidents, injuries, and/or death as a result of yoga related activities, and that I cannot hold Rebecca Wilhelm personally responsible for any liability. 

I recognize that any form of physical activity is a potentially hazardous one, and that they involve a risk of possible injury or even death.  I hereby affirm that I am voluntarily participating in these activities with the knowledge of risk involved.  I agree to expressly assume and accept any and all risks of injury and/or death.  

I hereby affirm myself to be physically sound and suffering from no condition, ailment, impairment, disease, or other illness that would prevent my participation in Yoga with Rebecca Wilhelm. I understand it is my personal responsibility to consult with my doctor regarding my participation. 

I agree to the release of my image in the form of photos or videography for the promotional use of Rebecca Wilhelm. 

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