Gina DuBois

Waiver of Liability and Disclosure Form


Please read, initial, and sign:

  1. I have requested to take in-studio or live streamed yoga classes provided by Hidden Haven Yoga, and Gina DuBois.
  2. I understand there is an inherent risk associated with any exercise program, including voluntary participation in yoga, which may result in injury or illness. The exercises related to yoga will challenge my cardio, respiratory and musculoskeletal systems associated with the aerobic, anaerobic, strength, power, flexibility and breathing components of the program. I understand and am aware that the components of exercise/yoga are potentially hazardous activities and may cause injury or death.
  3. I acknowledge that I have either had a physical examination and/or have been given permission from my physician to participate in a yoga based exercise program, or that I have decided to participate voluntarily without the approval of my physician and do hereby assume all responsibility for my participation in any exercise/yoga activity associated with Hidden Haven Yoga, LLC. & Gina DuBois.
  4. I certify that I am physically well and suffering from no medical problems, conditions, impairments, diseases or illness that would prevent my participation or increase the risk of injury and/or illness as a result of partaking in any exercise/yoga program.
  5. I understand that a person can be asymptomatic and can carry the COVID-19 VIRUS unknowingly and can transfer it person to person.
  6. I understand that even when following federal and state health guidelines one can still be infected with the COVID-19 VIRUS.
  7. I, my heirs, or legal representatives do hereby waive and release Hidden Haven Yoga, LLC, its teachers, and employees from any and all liability and responsibility from injury, accident, illness, legal and medical fees.
  8. I understand the Hidden Haven Yoga will provide and area for personal belongings to be held during class, however, I agree that Hidden Haven Yoga, LLC and Gina DuBois is in no way responsible for the loss or damage of my belongings while I attend class.
  9. I hereby give permission to Hidden Haven Yoga, Gina DuBois and/or their photographer(s) to use my name and photographic likeness in all forms and media for advertising, trade and any other lawful purpose.
  10. I understand that in-studio classes will be simultaneously live streamed on ZOOM to allow at-home students to participate. I understand there is a possibility that I will be seen on camera by at-home participants.

I acknowledge that I have read this waiver of liability form. I fully understand its terms and conditions and I understand that I am giving up my right to sue Hidden Haven Yoga, LLC, its teachers, and employees.

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Waiver of Liability and Disclosure Form
lock iconUnique Document ID: 01ddb4cec9f43027355d68b86b88a9216f7029a0
Timestamp Audit
June 29, 2020 3:32 pm EDTWaiver of Liability and Disclosure Form Uploaded by Gina DuBois - gndubois@optimum.net IP 173.62.11.33
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://ginaduboiswellness.com/
Audit Trail Serial# 862e3367237972223d1d3df261b7c0b5