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Children’s Yoga Class: Healthcare Questionnaire & Permission Form

Child’s Birthday
Day
Month
Year

Medical History and Health Information

Does your child have any of the following medical conditions?(Check all that apply)
Is your child currently taking any medications?
Does your child have any food or environmental allergies (e.g., latex, bee stings)
Does your child have any physical limitations or restrictions that would affect participation in yoga?
Has your child ever experienced dizziness, fainting, or fainting-like symptoms?
Does your child have any history of psychological concerns (e.g., anxiety, trauma, depression)?
Does your child wear glasses or contact lenses?

Yoga Class Participation Agreement & Consent

I, the undersigned, as the parent/legal guardian of the above-named child, hereby give permission for my child to participate in the children’s yoga class offered by Yogïbær. I acknowledge and agree to the following:


  1. Assumption of Risk:  

   I understand that participating in a yoga class involves physical activity and could carry a risk of injury. I assume full responsibility for my child's health and safety during the yoga sessions and agree to inform the instructor of any specific needs or medical concerns related to my child’s participation.


  1. Release of Liability:  

   I, the undersigned, hereby release Yogïbær, its employees, agents, and volunteers from any and all liability for any injuries, damages, or loss sustained by my child during the course of the yoga class. I acknowledge that my child is physically able to participate in the activities and that any medical conditions have been disclosed.


  1. Emergency Medical Treatment:  

   In the event of an emergency or injury during the class, I authorize the instructor or staff to administer first aid or seek medical attention for my child as needed.


  1. Behavioural Expectations:  

   I understand that my child is expected to follow the instructor’s guidance, respect others, and behave appropriately during the class. Inappropriate behavior may result in my child being asked to leave the session.


  1. Withdrawal from Classes:  

   I understand that I may withdraw my child from the yoga class at any time, provided I inform Yogïbær in advance.

 Parent/Guardian Acknowledgment & Signature

By signing below, I acknowledge that I have read and understood the information in this healthcare questionnaire and participation agreement. I give my permission for my child to participate in the yoga class and agree to the terms outlined above.

Date
Day
Month
Year

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