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Prepare for Your Session

Health Declaration & Waiver

Please fill out the following health declaration form and waiver in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.

Are you experiencing any of the following symptoms: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea?



I understand that yoga includes physical movements as well as many physical, cognitive and emotional benefits.  As with any physical activity, the risk of injury is always present.  If I experience any pain or discomfort, I will listen to my body, discontinue the activity and ask for support from the instructor.  I will continue to breath smoothly.  I assume full responsibility for any and all damages, which may occur through participation.


Yoga is not a substitute for medical attention, examination or diagnostic treatment.  By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program.  In addition, I will make the instructor aware of any or physical limitations before class.  I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk.  I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against the instructor.


I have read and fully understand and agree to the above terms of this Liability Waiver Agreement.  I am signing this Health Declaration & Agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by the law.

Thanks for submitting!

Susana Laborde-Blaj
Susana Laborde-Blaj Contact
Testimonials Susana Laborde-Blaj
Mexico Viniyoga Retreat

Please fill out the Waiver; then Save it in a PDF; then send back to me via email

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Health Intake Form
Please fill out the Health Intake Form; then Save it; then send back to me via email

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