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Liability Release &
Image/Media Release

Liability Waiver & Image/Media Release is Required for all (no exceptions)

(including all minors)

who participate in

Fire Fly Yoga & Reiki School LLC:


Yoga classes, Reiki services, Yoga & Reiki & Acting workshops, Yoga Teacher & Reiki Certification Trainings, Special events & programming.


FIRE FLY YOGA & REIKI SCHOOL LLC Release And Waiver Of Liability 

Name ___________________________________________________ 


Street Address _____________________________________________________


City, State  __________________________________________

Zip Code ____________________________________ 

Phone Number _________________________________________ 

Email ____________________________________________________


I, ____________________________________________, hereby agree to the following: 

1. I am participating in yoga classes, health programs, workshops and other exercise and healing arts activities (collectively, the “Activities”) offered by [Fire Fly Yoga & Reiki School LLC] (“Studio”) and/or its owners, instructors, teachers, workshop presenters, employees and independent contractors. _____________INITIALS

2. I recognize that I must be in good physical and mental health to participate in the Activities. I understand that the Activities require physical exertion and I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the Activities. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Activities. If I have consulted a physician, I have taken the physician’s advice. I understand that the Studio reserves the right in its absolute discretion to refuse my participation in an Activity on medical or fitness grounds. _____________INITIALS

3. I am in proper physical condition to participate in the Activities, and I am aware that participation could, in some circumstances, result in abnormal blood pressure, fainting, heartbeat disorders, physical injury and potentially heart attack. I also understand that I could experience muscle, back, or bone injuries during exercise. I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured. I understand that it is my continuing responsibility to inform the Studio of any previous medical conditions, injuries or surgeries prior to my first class and any future changes to my medical condition. _____________INITIAL

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 at the Studio. _____________INITIAL

5. I understand the risk of injury from Yoga and Fitness activities and using Any Yoga and Fitness equipment may be significant, including potential injury or death.  I knowingly and freely assume all such risks, both unknown and known. I acknowledge that I may engage in both privately supervised, group supervised, or unsupervised activity and I assume all risks of using equipment, movement or exercise routine or props with or without staff present. In addition I acknowledge that the business may include outdoor activities, which may present risks such as slippery surfaces, uneven surfaces, loos rocks/gravel, unseen landscaping issues and more. I hereby release, indemnify and hold harmless FIRE FLY YOGA & REIKI SCHOOL LLC, ANY ADDITIONAL AFFFILIATES including subcontractors, independent contractors, guest teachers, teacher trainees, workshop presenters, employs, etc. and the owner of this business that may be associated with this company, with respect to any and all injury, disability, death, loss or damage to person or property that may arise out of connection with this business or any use of its products, services or classes. _____________INITIAL

6. In further consideration of being permitted to participate in the Activities, I knowingly, voluntarily and expressly waive any “Claims” (as defined below) I may have against the Studio, its owners, members, employees, and/or its instructors, teachers, employees, volunteer staff, interns, and/or independent contractors and the landlord of the Studio (each, a “Released Party”) for any Claim that I may sustain as a result of participating in the Activities at the Studio even if the Claim arises from the carelessness or negligence of any Released Party or anyone else. I agree to indemnify and hold harmless each Released Party from any loss 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 carelessness or negligence of any Released Party or anyone else. _____________INITIAL

“Claims” include but are 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 children may suffer or that my unborn child may suffer (including any legal fees or expenses) in connection with participation in any Activity. _____________INITIAL

7. I, my heirs or legal representatives or personal representatives or assigns or any other next of kin forever release, waive, discharge and covenant not to sue any Released Party for any Claim caused by any negligence or other acts of a Released Party. _____________INITIAL

8. I hereby understand that the Studio from time to time may photograph or video classes or events occurring at its studios and place such photographs and videos on its Website. I hereby consent to the use of my image that may appear in any such photograph or video. _____________INITIAL

9. This agreement shall be construed in accordance with, and governed by, the laws of the State of ARKANSAS. 

I acknowledge that I have carefully read this release and waiver of liability and fully understand its contents. I voluntarily and knowingly agree to the terms and conditions stated herein. I am aware that by signing this release and waiver of liability, 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. 

___________________________________________ Print Name of Participant

___________________________________________ Signature of participant 

____________________________________________ Date 



If participant is under 18: 

As legal guardian of ______________________________________________, 


I consent to the above Waiver of Release and Assumption of Liability 

_______________________________________________ Print Name of Parent/guardian

________________________________________________Signature of parent/guardian 



I authorize Fire Fly Yoga & Reiki School LLC to record and edit my likeness, image, voice, interview and performance. I agree that Fire Fly Yoga & Reiki School LLC may use and authorize the use of any part of this documentation for, but not limited to, exhibition, publication, educational, promotional, advertising, video and website purposes. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse settings within an unrestricted geographic area. 

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against Cat McGowan and Fire Fly Yoga & Reiki School LLC utilizing this material for above purposes. 

Full Name: ___________________________________________________________________

Signature:_________________________________________  Date:______________

Address: ____________________________________________________________________________

City: ________________________________________________  Zip: ___________________ 


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