Release and Waiver of Liability Form

Please complete and sign the form below

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

YYYY

Preferred Method of Communication

Health - list any physical or medical conditions and/or limitations that you now have or have had in the last five years.

Are you pre or post-natal?

YES

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Summary of Waiver and Liability Release

I understand that I am participating in Pilates classes and/or Workshops offered by Rita Donahue during which I will receive information and instruction about movement and health. I understand that the practice of Pilates involves physical exertion that may be strenuous and may cause injury, and I am fully aware of the hazards involved. I also understand that it is my responsibility to consult with a physician prior to and regarding my participation in Pilates and/or Workshops. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in Pilates and/or Workshops. In consideration of being permitted to participate in Pilates and/or Workshops offered by Rita Donahue, I agree to assume the full responsibility for any risks, injuries or damages, known or unknown, that I may incur as a result of participating in these sessions or workshops. I knowingly, voluntarily and expressly waive any claim I may have against Rita Donahue for injury or damages that I may sustain as a result of participating in the sessions. I, my heirs and legal representative, forever release, waive, discharge and covenant not to sue Rita Donahue for any injury caused by her negligence or other acts. I acknowledge that it is my responsibility to inform the instructor of any injury or other condition that might affect my ability to participate at the beginning of every session. I also acknowledge that if I do wish to receive hands-on assistance, it my responsibility to inform the instructor when an assist has gone as far as I desire at that time. 24-Hour Cancellation Policy - In regards to Private, Duo or machine classes, I understand that if I do not allow at least 24 hours notice before cancelling a scheduled session I will be responsible for the full cost of the session.

I have carefully read the above Release and Waiver of Liability and fully understand and voluntarily agree to the above by signing and dating below.

Guardian Signature (necessary only if under 18)