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Consent form / Disclaimer
Consent form / Disclaimer
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Click Here to Add a Title
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: ______________