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Waivers

A waiver/release/consent form is required for all participants.  Please complete prior to your first session at Pistachio Yoga.  

For ALL Participants

(please click the below green button)

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For Participants 17 years old and under

(a total of 3 forms must be filled out)

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YOGA LIABILITY WAIVER & INTAKE FOR CHILDREN AND TEENS

I hereby agree to the following:

I am the parent or legal guardian of

(a minor/child/teen).


My child has permission to attend a yoga class at PISTACHIO YOGA LLC, 5206 N. Damen Ave., Chicago, IL 60625, OR offered by PISTACHIO YOGA LLC at a “Special Event” facility.


My child is participating in classes during which she/he will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my child’s participation in any physical fitness program, including yoga. I represent and warrant that my child has no medical condition that would prevent her/his participation in physical fitness activities.


I have read both the attached WAIVER OF LIABILITY, RELEASE, ASSUMPTION OF RISK, INDEMNITY

AND CONSENT AGREEMENT (“Full Waiver”), and MINOR PARTICIPATION AGREEMENT (“Participation Agreement”) fully and I understand that my child’s participation in the aforementioned yoga

classes shall be undertaken pursuant to the terms of that Full Waiver and Minor Participation Agreement, and agree to that Full Waiver and Minor Participation Agreement with my signature below, both personally and on

behalf of my minor child. I acknowledge my responsibility to go over the Minor Participation Agreement with my child and stress the importance of their adherence to the terms of the Minor Participation Agreement. The

Minor Participation Agreement was signed by myself and my child only after I have completed the afore-mentioned explanation. I affirmatively assert that I have explained the Minor Participation Agreement to my

Child and that they understand said Agreement.


In consideration of my child being permitted to participate in the yoga classes, I (for myself, and on behalf of my spouse/partner, child’s other parent, and my child) agree to assume full responsibility for any risks, injuries or damages, known and unknown, which my child might incur as a result of participating in the program. In further consideration of my child being permitted to participate in the yoga classes, I knowingly, voluntarily,

and expressly waive any claim I may have against the instructor, the owner, or the leaseholder of the building for injuries or damages that my child may sustain as a result of participating in classes or workshops held at or

conducted by PISTACHIO YOGA LLC.


I have read the above release and waiver of liability as well as the Full Waiver and fully understand its contents. I voluntarily agree to the terms and conditions stated therein.

Child's Birthday

PISTACHIO YOGA LLC

MINOR PARTICIPATION AGREEMENT

Beginning Date
Ending Date

This Participation Agreement (the “Agreement”), effective as of the date of signature by the Parent/Legal Guardian, is entered into by and between PISTACHIO YOGA LLC and Parent/Legal Guardian, personally and on behalf of the Participant. This Agreement must also be signed by the Participant, which signature reflects that the Parent/Legal Guardian and Participant have reviewed the Agreement and all materials linked to this Agreement; that the Parent/Legal Guardian has discussed the Program in detail with the Participant and has explained to the Participant that the Program may have risks and that Participant’s participation is voluntary; and that the Participant understands and agrees to all of the terms of this Agreement and all materials linked to this Agreement, including but not limited to the behavioral expectations.


1. Voluntary Participation; Program Description


(a) In return for and as a condition of PISTACHIO YOGA LLC providing to Participant the opportunity to participate in the Program, Parent/Legal Guardian hereby voluntarily agrees to allow the Participant to participate in the Program and agrees to the terms and conditions set forth in this Agreement. (b) PISTACHIO YOGA LLC reserves the right, in its sole discretion, to add, modify, or remove elements of the Program or cancel the Program. (c) PISTACHIO YOGA LLC may change or update the Minor Participation Agreement as well as other relevant policies. If that happens prior to or during the Program, PISTACHIO YOGA LLC will notify Parent/Legal Guardian of such updates via email. Such updates will take effect immediately and will apply to Participant’s continued participation in the Program. The continued participation by Participant in the Program will reflect that Parent/Guardian has read, understood, and agreed to any such updates. (d) Parent/Legal Guardian agrees that if they observe and unusual or specific concern in their Minor’s readiness for participation in the and/or in the Program itself, Parent/Legal Guardian will remove their Minor from the Program and bring such attention to PISTACHIO YOGA LLC immediately.


2. Behavioral Requirements; Participation Policies


(a) Parent/Legal Guardian understands and agrees that (i) Participant must comply with all behavioral requirements established by the Program; (ii) Participant must comply with all Covid-related guidance established by the Program, as the same may change from time to time; (iii) Participant must in all cases and at all times act with a high regard for the health and safety of Participant and others; and (iv) Participant must follow and not deviate from all the directions and procedures communicated to Participant by those operating the Program. 2 (b) Parent/Legal Guardian acknowledges and understands that Participant is subject to and must comply with all PISTACHIO YOGA LLC policies, rules, and regulations, applicable to the Program, as they now exist or are later amended. (c) PISTACHIO YOGA LLC may dismiss a Participant from the Program if PISTACHIO YOGA LLC determines, in its sole discretion, that • Participant has not complied with the behavioral requirements for the Program • Participant has not complied with the Covid-related guidance established by the Program • Participant has violated a law • Participant has violated any Program policy, any applicable PISTACHIO YOGA LLC policy, or any relevant third party policy • Continued participation by Participant in the Program poses a risk to the health, safety, or welfare of the Participant or others • Continued participation by Participant in the Program will materially disrupt the Program. (d) If PISTACHIO YOGA LLC dismisses Participant from the Program, PISTACHIO YOGA LLC will inform Parent/Legal Guardian of the decision. If Parent/Legal Guardian is unavailable, PISTACHIO YOGA LLC will inform an emergency contact, as designated by Parent/Legal Guardian. Once PISTACHIO YOGA LLC notifies the Parent/Legal Guardian or an emergency contact that

PISTACHIO YOGA LLC has dismissed Participant from the Program, the applicable person must pick up Participant and remove them from the Program as soon as possible.


3. Participant Behavioral Expectations (For Child/Participant)


(a) Parent/Legal Guardian, and Participant understand that yoga programs are in essence physical conditioning and training programs that require constant feedback and education, such that it requires collaboration and cooperation of the Participant with the Yoga instructor. Accordingly, Participant must at all times heed and follow the instructions of the Yoga Instructor to the best of their ability. (b) Participant agrees to report to Yoga Instructor, any change in their physical, mental or emotional well-being that may affect my ability to participate safely. This includes any additions of prescription medications or over the counter supplements. (c) Participant agrees to report and/or communicate to Yoga Instructor any time they feel any abnormal or labored physical response to yoga exercise (i.e. pain, nausea, shortness of breath, dizziness, etc.) and to stop the activity immediately. (d) Participant agrees to communicate with Yoga Instructor if they come become aware of another Minor Participants abnormal or labored physical, mental, or emotional response to any activity. (e) Participant agrees to treat other Minor Participants with politeness, respect and understanding. (f) Participant agrees to exhibit and maintain a polite and respectful demeanor and manner to all adults, including the Yoga Instructor.


4. Use of Photographs, Recordings.


(a) Parent/Legal Guardian gives permission and consent to allow photographs and video and audio recordings to be taken of Participant during the Program. (b) Parent/Legal Guardian further gives permission and agrees that (i) photographs or video or audio recordings of Participant taken during the program, and (ii) writings and other Participant work produced 3 during the Program, may be used in perpetuity in PISTACHIO YOGA LLC products, publications, web sites, and/or social medial channels. Parent/Legal Guardian releases and discharges PISTACHIO YOGA LLC from any and all claims and demands arising out of or in connection with the use of Participant’s likeness, voice or writings.


5. CONSENT TO HEALTH CARE FOR MINOR


a) In the event that Parent/Legal Guardian and/or Emergency First Contact are not available, Parent/Legal Guardian authorizes the Program staff to seek medical treatment for the Participant as they see necessary at any nearby medical facility. Parent/Legal Guardian understands that whenever possible, the Program staff will make a good faith effort to contact Parent/Legal Guardian before seeking treatment. If this is not possible, Parent/Legal Guardian understands that they will be notified by the Program staff as soon as possible of any and all diagnoses and treatments. b) Parent/Legal Guardian consents to any ambulance transport, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care subsequently deemed necessary by a licensed health care provider during the participant's session. Parent/Legal Guardian understands that this authorization is given in advance of any specific diagnosis, treatment or hospital care, and that it is given to provide the Program staff authority to seek medical treatment, and to provide a licensed health care provider the authority to administer this treatment as s/he judges necessary to the Participant. c) Parent/Legal Guardian accepts responsibility for payment of all services rendered; Parent/Legal Guardian authorizes any medical facility which renders services to release medical information necessary for the processing of insurance claims; and Parent/Legal Guardian authorizes the payment of insurance claims directly to the medical facility.

6. ASSUMPTION OF RISK; RELEASE AND WAIVER OF LIABILITY


(a) The Program may involve risks to health and safety, including but not limited to those described in the Full Waiver. Parent/Legal Guardian agrees to accept and assume all present and future risks, known or unknown and whether described in the Full Waiver or not, to Participant’s health and safety that may arise from or be caused by Participant’s participation in the Program. Parent/Legal Guardian agrees that Parent/Legal Guardian has explained these risks to the Participant. (b) In return for and as a condition of PISTACHIO YOGA LLC providing Participant with the opportunity to participate in the Program, and having read and understood this Agreement, including this Release and Waiver of Liability, Parent/Legal Guardian hereby agrees to the following:


TO RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE PISTACHIO YOGA LLC, Christianne Reynoso, and/or its Landlord, staff, Yoga Instructors, employees, agents, assigns and successors or any affiliates, and all other persons or entities involved in the Program (hereinafter referred to as “Releasees”), (i) for any liability, claim, and/or cause of action arising out of or related to any loss, damage, injury, illness, or harm of any sort, including injury, illness, or death, that may be sustained by Participant and (ii) for loss of or damage to any property belonging to Participant and/or Parent/Legal Guardian; and that occurs (A) as a result of participation in the Program (including during travel to and from the Program site); (B) as a result of exposure or possible exposure to Covid-19 or any actual, alleged, or threatened infectious, pathogenic, toxic, or other harmful properties of any organic pathogen (including during travel to and from the Program site); (C) as a result of any emergency evacuation facilitated by PISTACHIO YOGA LLC; and/or (D) as the result of any medical care Participant receives while participating in the Program, including any medical care authorized or procured by PISTACHIO YOGA LLC. If Participant deviates from any aspect of the Program and engages in a personal activity that is 4 not part of the Program, such deviation is purely voluntary and Releasees shall not be liable for any injuries resulting or arising out of such deviation.


7. Governing Law


The laws of the State of Illinois without regard to principles of conflicts of laws, govern this Agreement. Any action based on or arising out of this Agreement shall be brought and maintained exclusively in the Cook County Circuit Court.


PARENT/LEGAL GUARDIAN:

I am the Parent/Legal Guardian of the above-named Participant. I certify that, before signing this Agreement, I have obtained written permission from any person who is otherwise legally entitled to custody of the Participant during the Program, to the effect that the Participant may fully participate in the Program.


PARTICIPANT:

My Parent/Legal Guardian has reviewed this Agreement with me and has explained that the Program may have risks and that my participation is voluntary. I understand and agree to all of the terms of this Agreement, including, but not limited to, the behavioral expectations.

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