Mt. Shasta July 7-14, 2017 Retreat WAIVER

I, the undersigned, understand that THE Mt. Shasta RETREAT including Qoya, breath work, energy work, and teachings are not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including Qoya. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every class. I will not perform any movements to the extent of strain or pain. I accept that neither the instructor, nor the hosting facility is liable for any injury or damages to person or property resulting from taking of the class. Those under 18 years of age must have this form signed by a parent or guardian.

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Please sign and scan and email to amy@amytatsumi.com