AMIA Virtual Yoga Class Waiver & Registration Form

This form serves as your registration and waiver acknowledgement to the Virtual Yoga class(es) being offered during the AMIA 2021 Virtual Clinical Informatics Conference. You must be registered for the Clinical Informatics Conference in order to attend.

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* 1. Virtual Yoga Class Registration - Name and Email
Please enter your name as it appears on your AMIA registration.

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* 2. Please enter the email address you’d like the Zoom link to the class to be sent. We will email you the link to the Virtual Yoga Class(es) you select below, the day prior to the class via calendar appointment.

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* 3. Please select the classes you'd like to attend from the options below.

Welcome to Yoga - Tuesday, May 18 - 8:00– 9:00 a.m. EDT - Zoom class room opens at 7:45 a.m.

Upper Body Yoga - Wednesday, May 19 - 8:00– 9:00 a.m. EDT - Zoom class room opens at 7:45 a.m.

Lower Body Yoga - Thursday, May 20, 8:00– 9:00 a.m. EDT - Zoom class room opens at 7:45 a.m.

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* 4. I hereby acknowledge and agree to the following as conditions of my participation in the AMIA 2021 Virtual Yoga Classes:

1. I am participating in virtual yoga classes offered during the AMIA 2020 Virtual Annual Symposium, and I understand that this waiver covers this activity online (virtually).

2. These activities may include physical movements, as well as an opportunity for relaxation, stress-reduction, and relief of muscular tension. I recognize that I must be in adequate physical and mental health to participate in this activity. I understand that this activity activities may require intense physical exertion, and by participating acknowledge that I am self-aware of my physical limitations and am fit enough to participate.

3. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. I acknowledge that potential risks of physical activity may include high-blood pressure, fainting, heartbeat disorders, physical injury, heart attack, stroke, muscle pain, and injury. I understand that participation can potentially aggravate a pre-existing physical injury or medical condition and am participating with my own consent. If I experience pain I will listen to my body, adjust, or come out of the posture.

4. I understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment, and the yoga instructor is not a medical professional.

5. 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 virtual yoga class. I affirm that I alone am responsible for deciding whether to practice.

6. I knowingly, voluntarily, expressly, and irrevocably release and waive any claim (and costs assumed as a result of claims) I may have now or hereafter against AMIA or Willow Street Yoga Center instructors that I may sustain as a result of participating in this virtual yoga activity even if the claim arises from the negligence.

7. 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.

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* 5. I hereby acknowledge and agree to the following as conditions of my participation in the AMIA 2021 Virtual Yoga Classes instructed by Maria Hamburger.

The practice of yoga and movement you are about to take part in requires you – the practitioner – to gauge the safety of your practice within your personal physical limitations. The techniques and suggestions presented in this class are not intended to substitute for proper medical advice nor should be used as such. Maria Hamburger Yoga assumes no responsibility for injuries connected with this class.

AMIA Virtual Yoga Class Waiver & Registration Form

Question Title

* 1. Virtual Yoga Class Registration - Name and Email
Please enter your name as it appears on your AMIA registration.

Question Title

* 2. Please enter the email address you’d like the Zoom link to the class to be sent. We will email you the link to the Virtual Yoga Class(es) you select below, the day prior to the class via calendar appointment.

Question Title

* 3. Please select the classes you'd like to attend from the options below.

Question Title

* 4. I hereby acknowledge and agree to the following as conditions of my participation in the AMIA 2021 Virtual Yoga Classes:

Question Title

* 5. I hereby acknowledge and agree to the following as conditions of my participation in the AMIA 2021 Virtual Yoga Classes instructed by Maria Hamburger.

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* 6. Please type your first and last name in the box below as Step 1 of your Electronic Signature.

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* 7. Please type today's date in the box below as Step 2 of your Electronic Signature

AMIA Virtual Yoga Class Waiver & Registration Form

Question Title

* 1. Virtual Yoga Class Registration - Name and EmailPlease enter your name as it appears on your AMIA registration.

Question Title

* 2. Please enter the email address you’d like the Zoom link to the class to be sent. We will email you the link to the Virtual Yoga Class(es) you select below, the day prior to the class via calendar appointment.

Question Title

* 3. Please select the classes you'd like to attend from the options below.

Question Title

* 4. I hereby acknowledge and agree to the following as conditions of my participation in the AMIA 2021 Virtual Yoga Classes:

Question Title

* 5. I hereby acknowledge and agree to the following as conditions of my participation in the AMIA 2021 Virtual Yoga Classes instructed by Maria Hamburger.

Question Title

* 6. Please type your first and last name in the box below as Step 1 of your Electronic Signature.

Question Title

* 7. Please type today's date in the box below as Step 2 of your Electronic Signature

* 1. Virtual Yoga Class Registration - Name and Email
Please enter your name as it appears on your AMIA registration.