Registration & Waiver
Registration and Informed Consent for Yoga, Meditation & Reiki Sessions
The Yoga With Bindu Center offers specialized yoga and meditation sessions focusing on various health conditions and Reiki healings with no-touch contact.
These sessions incorporate gentle, targeted movements designed to support specific health needs while promoting overall well-being. While beneficial for many, these classes are complementary to — and not replacements for — medical treatment. Your safety is our priority. Please consult your healthcare provider before beginning this or any exercise program.
All participants must complete and submit this informed consent form prior to joining any class. Registration will only be confirmed upon receipt of your completed form.
Choose Your Path
Select one to continue. You can register for the other service separately.
01
No-touch energy healing sessions for relaxation, balance, and restoration.
02
Gentle, breath-centered movement and meditation for body, mind, and soul.
03
Host a dot mandala paint party or workshop — birthdays, girls nights, corporate events, and more.
Reiki Healing
Experience the power of Reiki — healing without physical touch. Discover how Reiki can transform your mind, body, and spirit.
Yoga & Meditation
All classes include yoga, breathing practices, and meditation. Modifications are always offered.
Dots With Bindu
Bindu brings the joy of dot mandala art to your gathering — paint parties, birthdays, girls nights, corporate events, and more. Share your vision and she'll be in touch with a custom quote.
Payment
Payment is to be made to Bindu Gupta by Venmo or Zelle at 774-253-5571. To confirm your spot, payment must be received at least 1 day before class. No refunds.
@BinduGupta
Scan to pay on Venmo
Informed Consent
Please read carefully before signing.
I, the undersigned, fully understand and appreciate the risk of participating in the program and knowingly accept it as my responsibility. I understand that I am undertaking this program of my own FREE WILL, in consideration of being permitted to participate in the yoga classes, Reiki (no touch) Healings, health programs, and workshops of yoga/yoga therapy training and yoga-based techniques offered by Yoga With Bindu.
I, the undersigned, hereby for myself, my heirs, executors, administrators and assignees, waive and release any and all rights, claims for damages I may have against any one involved, like 'Yoga With Bindu' or Bindu Gupta as individually or separately for any personal injuries or property damage of any and whatever type, nature and amount sustained or claim to be sustained by me as a result of my entrance and participation in the Yoga / Reiki / Meditation program.
Furthermore, I, the undersigned, will never institute any action or suit at law or in equity against covenant, nor institute, prosecute or in any way aid in the institution or prosecution or any claim, demand, action or cause of action for damage, costs, loss of services, expenses, or compensation for or on account of any damage, loss or injury either or personal property, or both, whether developed or underdeveloped; resulting or to result; known or unknown; past, present or future; arising out of participation.
I recognize that the practice of Yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga sessions. I have no medical condition that would prevent my full participation in the Yoga (Therapy) Training or receiving Reiki (no touch) healings.
I, the undersigned, fully understand the following and know that it pertains to myself: "While practicing all Yoga movements, I will not go beyond the point of pain. Under any circumstances, I will avoid straining myself. In case of pain/strain, I will unwind the movement to alleviate the pain/strain. I also understand that yoga exercises contain movements in which you will be upside down and constantly stretching every muscle in the body, and any or all of these movements could result in serious injury or even death. By signing this document, I take full responsibility for any injury or death. 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 do not have any medical conditions that would adversely affect me while undergoing this Yoga training. I appreciate the opportunity to participate. If needed, I have or will consult my personal Doctor."
The class may be recorded or photographed and may be used for promotion. I am OK with it.
My electronic signature/printed name is binding to this liability waiver from this day forth.
For students and kids: Ages 16 and above may complete this form. Below the age of 16, parents must fill out this form before the class begins. Please fill out only 1 form per participant.
By typing your name above you confirm that you have read, understood, and agree to the terms above. Your typed name constitutes a legally binding electronic signature.
After submitting, Bindu will be in touch within 1–2 business days to confirm your session details.
Thank you for registering with Yoga With Bindu. Your form has been submitted and Bindu will be in touch within 1–2 business days to confirm your session.
Please ensure payment is sent to @BinduGupta on Venmo or via Zelle at 774-253-5571 at least 1 day before your session.
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