RELEASE & WAIVER OF LIABILITY FORM Download Paper Copy Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Date of Birth MM DD YYYY Health: list any physical or medical conditions and/or limitations that you now have or have had in the last five years. Emergency Contact First Name Last Name Emergency Contact Phone (###) ### #### Release I will receive information and instruction about movement and health while participating in the training session, class, or workshop offered by Maple Street Pilates, LLC. I recognize that the practice of Pilates will require 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 personal Pilates training sessions, classes, and/or workshops associated with Maple Street Pilates, LLC or Aurora Zisner. I represent and warrant that I am physically fit and have no medical conditions that would prevent my full participation in personal training, classes, or workshops. I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which may incur as a result of participating in personal Pilates training, classes or workshops. I knowingly, voluntarily, and expressly waive any claim that I may have against Maple Street Pilates, LLC or Aurora Zisner for injuries or damages that I may sustain as a result of my participation. I, my heirs and legal representatives forever release, waive, discharge and covenant not to sue Maple Street Pilates, LLC or Aurora Zisner for any injury or death caused by negligence or other acts. I acknowledge that it is my responsibility to inform the instructor when I begin a Pilates session, class or workshop of any injury or other condition that might affect my ability to participate. I also acknowledge that if I do wish to receive hands-on assistance, it is my responsibility to inform the instructor when an assist has gone as far as I desire at that time. 24-Hour Cancelation Policy: I understand that if I do not allow at least 24 hour notice before canceling a scheduled session I will be responsible for the full service charge. Yes, I agree Date * MM DD YYYY Signature * Thank you!
