Consent Form

Parent / Guardian Full Name:_____________________________

Child’s Full Name _____________________________________

Boy/ Girl / Non binary:__________________________________

Age:______________

Address : ____________________________________________

_________________________________ Post code___________

Email :___________________________________

How did you hear about us?______________________________

(Mobile Phone)_____________________________

(Home Phone)______________________________

Emergency Contact Name: ______________________________

Relationship: ______________________________

Emergency Contact Phone:______________________________

Doctor’s Name: ___________________________

Doctor’s Contact Phone: ____________________

Known Allergies / Physical Limitations / Concerns: _________

____________________________________________________

Disclaimer.

Individually and also as parent and / or guardian of the minor child above, I hereby

acknowledge the following notes and grant to Hannah Parsons of The Inky squid Yoga and

Mindfulness, the following consent from liability and negligence:

Liability Release:

I acknowledge and fully understand that I and / or my child will be engaging in physical

activities that may involve risk of injury. I acknowledge that I have been advised to consult

with my, or my child’s physician with respect to any past or present injury,

illness, health problem or any other condition that may affect my and / or

my child’s participation in this yoga program.

I assume the foregoing risks and accept personal responsibility for any and all personal

injuries sustained by my child and / or myself and discharge and hold Hannah Parsons of The

Inky Squid, it's owners, members, teacher’s, employees, from any claim, cause of liability for

damages arising from any injury to my child’s person, my person, or other persons or

property caused by my, or my child’s participation in The Inky squid yoga program,

including the negligence of Hannah Parsons of The Inky squid.

In the event that I / or my child become ill, or injured during, or as a result of participation in

the class, I hereby allow Hannah Parsons of The Inky squid to arrange for such emergency

medical services as deemed necessary.

We request 24 hours notice if you are unable to attend a pre-booked class (may not apply

under some special circumstances) as numbers are limited.

Parent / Guardian Signature: ____________________________________

Date: ______________

I have been informed and agree that photographs / videos may not be taken of my child and / or

any other minor during class

Parent / Guardian Signature:___________________________________

Date: ______________