Florida Atlantic University (Boca Raton)
PHYLLIS AND HARVEY SANDLER
SCHOOL OF SOCIAL WORK

Robin Rubin Center for Happiness and Life Enhancement
Waiver, Release & Hold Harmless Agreement

We’re excited to have you join us for Wednesday Yoga at 12:00PM brought to you by the Robin Rubin Center for Happiness & Life Enhancement. Please take a moment to complete the required event waiver below. Then click “Submit” to receive the registration link.

Note: Completion of this waiver grants you access to as many Wednesday Yoga events that you wish to attend through April 23, 2021. You will need to complete a new waiver for each new course you attend. Thank you for understanding.

I am aware that participation in any wellness program involves risk.  I understand that the dangers and risks of participation in a wellness program, (e.g. yoga, stretching, meditation, etc.),  include, but are not limited to death, serious neck and spinal injuries, which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles, tendons and other aspects of the muscular skeletal system and serious injury or impairment to other aspects of my body, general health and well-being.  I understand that the dangers and risks of any wellness program participation may result not only in injury, but serious impairment of my future abilities to earn a living, to engage in other business, social, and recreational activities and generally to enjoy life.  Some wellness programs includes skill training in relaxation and meditation methods as well as gentle stretching exercises. I understand that if for any reason I am unable to engage in these techniques, either during the weekly sessions or at home, I am under no obligation to engage in these techniques, and I agree that I will exercise my own independent judgment in assessing my physical ability to engage in these techniques.

I hereby recognize and assume all the risks associated with participation in the wellness program and release the State of Florida, Florida Atlantic University, the Sandler School of Social Work,  and their respective Trustees, employees, officers and agents, and I hold them free and harmless of and from all actions, causes of action, claims, damages and costs arising from and accruing to me on account of death or any and all accident or injury to me, either directly or indirectly sustained by me as a consequence of my travel to or from, or my participation in any activities related to the wellness program offered by the Sandler School of Social Work.  This release and waiver is intended by me to release the University from all causes of action, including but not limited to causes of action based upon the university’s own negligence, as well as any causes of action based upon the negligence of any trustee, officer, agent, employee or independent contractor hired by or working for the University.  The terms hereof serve as a release and assumption of risk for myself, my heirs, estate, executor, administrator, assignees and for all members of my family.

I recognize and acknowledge that Florida Atlantic University and the Sandler School of Social Work do not carry any type of accident or health insurance policy on the participants in the wellness program.  I also realize that sports and fitness injuries can be catastrophic for those without proper medical coverage. 

I am lawful age (age of majority is 18 years +) and legally competent to sign this waiver and release and I have signed the document of my own free will and action.  I hereby consent to any publicity, including the use of my name and likeness, in connection with my participation in these activities at Florida Atlantic University.

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* 1. Please type  your name to sign:

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* 2. Today's Date:

Date

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* 3. Your Email Address:

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* 4. Your Gender

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* 5. Your Age

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* 6. Your Phone Number

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* 7. Year in School:
    (Note: after you complete this question you will be redirected to the registration page.)

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