Waiver for In-Person Classes

Please Fill this form in completely prior to your first class

First Name

Email Address

Last Name

Date of Birth

Have you been hospitalized in the last 12 months?

Yes

Are you currently suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Waiver and Release of Liability:

I understand that I will be participating in a fitness program. I am not required to do any of the activities instructed and that I will use my own judgement to my ability. I can rest at any time during the class. It is important that I listen to my body and respect the limits that I have on any given day. I will not perform any of the exercises to the point of pain or strain. If I feel any discomfort or strain I will gently come out of the exercise and not proceed further with the class and seek medical attention. I understand that Essentrics is not a substitute for medical attention, examination, diagnosis, or treatment. I know the importance of communicating with my doctor prior to the start of any fitness program. I will inform my instructor of any new injuries, conditions or health concerns before class begins. I accept that neither the instructor nor the facility is responsible for any injury, or damages, to person or property resulting from taking this class. I assume all risks and hereby assume all risks associated from this point forward and give my consent to participate in the program.

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!