Natia will be facilitating a wellness activity block during HA’s retreat at Narmada Winery in VA.

More information about Natia’s style/approach to yoga class facilitation can be found **here**.

This session will begin and end promptly at the times posted on the itinerary. Items needed for the session will be provided, including: yoga mats (limited), yoga blocks (limited), and disinfectant wipes for mats/blocks.

We plan to be outside on the patio under a pavilion. If temperatures are too warm to be outside comfortably for 30 minutes, we will hold the session inside.

If you are interested in joining this session, please take the following poll to help Natia meet your wants/needs at this event!

After completion of the poll, please sign the waiver below!

Name

First Name

Last Name

Email

(This is so you can receive an emailed copy of the waiver. Natia will respect your privacy, and you will not receive any marketing/communication from Natia, unless you click to sign up for news and updates.)

Emergency Contact Name

Emergency Contact Relation

Emergency Contact Phone

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Informed Consent, Liability Disclaimer & Notices

(please read carefully) I will be attending the yoga class as part of a group and that the class will not be specifically designed to my individual needs. The yoga class will begin at a low level of physical movement and various stages of adaptation will be given for my choosing. Asana (yoga posture) means posture easily held. If it’s too hard or if it hurts, you can stop! You may rest at any time during the class. It is important in yoga that you listen to your body and respect its limits on any given day. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. In the case where I have/experience sickness or anything else that may be affected by physical activity, I have consulted with physician to ensure that I/my child can take yoga classes. I recognize that is is my responsibility to notify the instructor of any serious illness or injury before every yoga class. In further consideration, I knowingly, voluntarily and expressly waive any claim I may have against Natia Gordon-Howell, and the owner/lessor of the Premises for injury or damages that I may sustain while on the Premises as a result of participating in the yoga class. I, my heirs or legal representatives irrevocably covenant not to sue and forever release, waive, and discharge any other claims of any kind whatsoever against Natia Gordon-Howell or the owner/lessor of the Premises for any personal injury, property loss or damage, or wrongful death, whether caused by negligence or otherwise. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. I accept that neither the instructor, nor the hosting facility is liable for any injury, or any damages, to person or property, resulting from the taking of the class. This agreement is binding on my heirs, executors, administrators and assigned. Please note that Natia uses aromatherapy in the form of incense. If I have issue with the use of incense, advise Natia before each class. I hereby grant Natia Gordon-Howell permission to use my likeness in a photograph in any and all publications, including website entries, without payment or any other consideration. By typing my name below, I am signing in agreement with the terms above.

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