I, (**PRINT NAME BELOW**), knowingly and willingly agree to participate in Yoga and/or Pilates instruction at Ashtanga Yoga Houston, LLC and/or Montrose Mindful Movement (herein referred to as AYH/MMM) during the COVID-19 pandemic. I understand that the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing. The nature of the teaching environment at AYH/MMM (one room with limited ventilation) is considered an environment that is higher risk for the spread of the COVID-19 virus.

I understand that due to nature of this environment and the characteristics of the virus, even with safety protocols in place (cleaning/disinfecting, 6ft distancing, mask requirement, etc.), that I am at risk of contracting the virus simply by being present in the yoga studio. I understand that due to nature of this environment and the characteristics of the virus, even with safety protocols in place (cleaning/disinfecting, 6ft distancing, mask requirement, etc.), that I am at risk of contracting the virus simply by being present in the yoga studio. YES, I UNDERSTAND

I confirm that I am not presenting any of the following symptoms of COVID-19: ★ Recent/new onset coughing (not related to allergy or COPD) ★ Nasal congestion/runny nose (not related to allergies or sinus infections) ★ Recent/new onset sore throat/dry cough ★ Recent/new onset shortness of breath (not related to chronic disease) ★ Recent/new onset diarrhea ★ Recent/new onset of loss of taste/smell ★ Recent/new onset of nausea/vomiting ★ Recent/new onset of fatigue/malaise I confirm that I am not presenting any of the following symptoms of COVID-19: ★ Recent/new onset coughing (not related to allergy or COPD) ★ Nasal congestion/runny nose (not related to allergies or sinus infections) ★ Recent/new onset sore throat/dry cough ★ Recent/new onset shortness of breath (not related to chronic disease) ★ Recent/new onset diarrhea ★ Recent/new onset of loss of taste/smell ★ Recent/new onset of nausea/vomiting ★ Recent/new onset of fatigue/malaise YES, I CONFIRM

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. In the last 14 days: ★ I verify that I have not travelled via airline, bus, or train ★ I verify that I have not stayed overnight in housing that is not well known to me (i.e. hotel) I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. In the last 14 days: ★ I verify that I have not travelled via airline, bus, or train ★ I verify that I have not stayed overnight in housing that is not well known to me (i.e. hotel) YES, I VERIFY

I confirm: ★ I have not been in contact with an individual positive for COVID-19 ★ I am not living with someone who is quarantined I confirm: ★ I have not been in contact with an individual positive for COVID-19 ★ I am not living with someone who is quarantined YES, I CONFIRM

In the case that I have tested positive for COVID-19, I confirm: ★ I have received a COVID-19 negative test and physician clearance out of quarantine ★ I have been under the care of a physician and have been cleared for physical activity In the case that I have tested positive for COVID-19, I confirm: ★ I have received a COVID-19 negative test and physician clearance out of quarantine ★ I have been under the care of a physician and have been cleared for physical activity YES, I CONFIRM

Although there are no guarantees in regard to the possibility of contracting COVID-19, AYH/MMM and its teachers will be following safety protocols as to best protect myself and themselves during teaching sessions. Although there are no guarantees in regard to the possibility of contracting COVID-19, AYH/MMM and its teachers will be following safety protocols as to best protect myself and themselves during teaching sessions. YES, I UNDERSTAND THAT I AM ELECTING TO PARTICIPATE AT THIS TIME.

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