Pilates class waiver Name * First Name Last Name Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Occupation Date of birth * MM DD YYYY Level of experience Beginner Intermediate Advanced Check the box below to agree to the following * I hereby agree: 1) That I am participating in group classes, offered by One Physical Therapy and Wellness, LLC, during which I will receive information and instruction about fitness, yoga and health. I recognize that these classes require physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2) I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any group classes, health programs or workshops. I represent and warrant that I am physically fit and I have no medical condition, which would prevent my full participation in the classes. 3) In consideration of being permitted to participate in the classes, 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 program. 4) In further consideration of being permitted to participate in the classes, I knowingly, voluntarily and expressly waive any claim I may have One Physical Therapy and Wellness, LLC, for injury or damages that I may sustain as a result of participating in the program. 5) I, my heirs or legal representative forever release, waive, discharge and covenant not to sue One Physical Therapy and Wellness, LLC, for any injury or death caused by their negligence or other acts. 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 agree Date * MM DD YYYY Thank you!
