BlissYogi.com Liability Waiver of Release
Please print the whole document. Scan or take a photo of the completed pages (2) and email to Deepa@BlissYogi.com.
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Student Name: ______________________________________________________
Full Address: __________________________________________________________________________________
Phone number: ______________________________________________________
I, __________________________________________________, hereby agree to the following:
1. I am participating in yoga classes or private sessions (health programs, workshops an/or other therapy or
healing arts activity, collectively the “Activities”) offered by Deepa Maria Mazzi and BlissYogi.com (the
Teacher). The Activities may be offered in the physical location of a Studio, private home, recreation center or
offered online by videos, television, podcasts, apps or other digital media or platforms. All of such offerings,
either physical or online, shall be considered “Activities”.
2. I recognize that I must be in adequate physical and mental health to participate in the Activities. I understand
that the Activities may require physical exertion, and I represent and warrant that I am physically fit enough to
participate, and I have no medical condition which would prevent my full participation in the Activities.
I recognize that the Activities may cause or aggravate a physical injury or medical condition. I understand that it
is my responsibility to consult with a physician before my participation in the Activities. If I have done so, I
have taken the physician’s advice. I understand that the Teacher reserves the right to refuse my participation in
any Activity on medical, fitness or other grounds.
3. I am aware that my participation in Activities could result in high blood pressure, physical injury, other
conditions, and may aggravate pre-existing injuries. I understand that I could experience muscle, back, neck and
other injuries as a result of my participation in the Activities. I understand my physical limitations and I am
sufficiently self-aware to stop or modify my participation in any Activity before I become injured or aggravate a
4. In consideration of being permitted to participate in the Activities, I agree to assume full responsibility for
any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the
Activities, including those which may result from the negligence of the Teacher.
5. In further consideration of being permitted to participate in the Activities, I knowingly, voluntarily and
expressly waive any “Claim” (as defined below) I may have against the Teacher or assistants (each a “Released
Party”) that I may sustain as a result of participating in the Activities even if the Claim arises from negligence
of Released Party or anyone else.
I agree to indemnify and hold harmless Released Party from any loss, cost, or liability incurred in defending any
Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or did result from
the negligence of Released Party or anyone else.
“Claim” includes but is not limited to any and all liabilities, claims, demands, expenses, fees, legal actions
rights of actions for damages, personal injury, mental suffering and distress, or death that I may suffer, my
spouse, children or unborn child may suffer (including any legal fees or expenses) in connection with
participation in any Activity.
6. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any Released
Party for any Claim caused by any negligence or other acts of any Released Party.
7. I hereby understand that the Teacher from time to time may photograph, video or otherwise record Activities
and place such photographs and videos on it’s Website or social media platform. I hereby consent to the use of
my image that may appear in any such photograph or video.
8. This agreement shall be construed in accordance with, and governed by, the laws of the State of California
and that all actions, suits, claims and proceedings relating to this agreement shall be brought in a court of
competent jurisdiction located in San Diego, California. In case any provision of this agreement shall be held
invalid, illegal or unenforceable, it shall not affect any other provision of this agreement and this agreement
shall be construed as if such provision had never been contained therein. I acknowledge that I have carefully
read this agreement and fully understand its contents. I voluntarily and knowingly agree to the terms and
conditions stated herein. I am aware that by signing this agreement, I am giving up substantial rights, including
my right to sue and certain legal rights my heirs, next of kin, executors, administrators and assigns may have
against any Released Party.
Signature of Participant: ____________________________________ Date: _______________
If participant is under 18:
As legal guardian of ____________________________________, I consent to the above Release and Waiver of Liability.
Signature of Guardian: ____________________________________ Date: _______________