Hot Stone Waiver Form

    We work with our students to ensure the most enjoyable and beneficial experience possible during your Classes, Workshops & Hot Stone Restorative sessions. Please assist us by completing the following information (all information is held in the strictest of confidence):


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    Emergency Contact Information:


    Caution is advised for Hot Stone Restorative Yoga to clients who have or experience
    the following:

    ● sensitive skin
    ● Uncontrolled blood pressure
    ● Diabetes (obtain physician approval)
    ● High blood pressure
    ● Pregnant (obtain physician approval)
    ● Cancer patients receiving chemotherapy or radiation (obtain physician approval)
    ● low platelet count, blood clots, bleeding
    ● bruise easily
    ● Open wounds, bruises or broken skin
    ● Diabetes (obtain physician approval)

    Please review this list and select those conditions that have affected your health either currently of recently:

    Broken/dislocated bonesPregnancyHigh/low blood pressureArthritis, bursitisDisc problemsBack problemsCancerHeart condition/Chest painAuto-immune condition (AIDS, fibromyalgia, chronic fatigue, lupus, etc)Diabetes type 1 or 2Muscle strain/sprainSurgerySeizuresScoliosisAsthma/ short breathOsteoporosisNumbness, tingling anywhereNo issues of concern

    If any of the information on this form needs further detail, or if there is anything else to share, please do so here:

    About this class:

    ● Please wear comfortable close fitting/yoga style clothing.
    ● Stones are gently warmed to a comfortable temperature but everyone experiences temperature tolerances differently. If you are sensitive to heat you may consider wearing long pants/leggings and or long sleeves.
    ● Tanya is aided in these classes by her assistant, Jason. Both are certified in Hot Stone Massage. Tanya is an experienced yoga teacher with certifications in multiple disciplines including restorative & hot stone restorative yoga

    You are responsible for your own wellbeing. By signing (electronic signature) below, you agree that the information provided above has been completed honestly & to the best of your knowledge. You also agree to take on full responsibility for your actions within the class and shall work within your own limits. If you have any inquiries or health concerns, it is your responsibility to notify Tanya before or during class. If you are in doubt as to your fitness or level of health, please consult your physician before taking this class.

    I agree to the above noted requirements:

    Name:
    Date: