The Confidence Coach

SECTION A:

Participant First Name (s): *

Participant Last Name: *

Date of Birth: *

Date

Parent or Legal Guardian Name

First Name Last Name

Primary Email Address: Our primary method of communication is email -- by providing your email, you agree to be added to our Email list.You can unsubscribe at any time. *

Mobile Phone: *

Address: *

City: *

Postal Code: *

SECTION B:

ALL CLIENTS , PLEASE NOTE: Make-up classes for ANY registered programs are not provided.

Registration Investment:

10 week Group Coaching $ 199.00 CAD

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Please advise of any medical conditions the child(ren) have; if required, we may request medical clearance for participation in the program *

SECTION C : Liability and Disclaimer.

Your Signature Below after reading the liability and disclaimer waiver below: *

SECTION C: WAIVER ALL PARTICIPANTS - Liability Wavier; please read carefully. Glossary: "Club/Studio" refers to South Asian Arts Movement Society, The Balance Code Yoga & Wellness Ltd. and The Confidence Coach, and Ashley Anjlien Kumar, and any associated partners/representatives involved in the class/event. Assumption of Risk of Injury and Wavier of Claims: I assume all risks of injury and waive all rights to pursue money damages or any other relief of any kind as a result of anything occurring at or near the Club/Studio location or any other venue used by the Club/Studio or its employees, officers, directors or other representatives (including but not limited to dance and/or fitness instructors and/or personal trainers and/or artists managed by the Club/Studio and/or contractors of any type). In the event I am injured while on a property the Club/Studio uses to conduct classes, performances, or workshops, I will hold harmless the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from all claims of any sort for damages or relief, including but not limited to claims for contribution. I acknowledge there is possible danger connected with any physical activity (including the dangers of physical injury and death) and knowingly and voluntarily waive my right to make a legal or equitable claim of any sort against the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from all claims of any sort for damages or for other relief, including but not limited to claims for contribution. This assumption of risk and wavier of liability applies to my family members, successors, heirs, and assigns. Physical Condition and No Medical Advice: I represent that I am in good physical condition and have no medical reason or impairment that might prevent me from my participation or intended use of the Club/Studio and the services offered. I acknowledge that the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns will not and cannot provide me medical advice relating to my physical condition and ability to use the facilities/participate in programs/classes. If I have any health or medical concerns now or after joining a class, I will discuss them with my doctor before attending & participating in any classes or using the Club/Studio"s services. Death/Disability Clause: If I die or become totally or permanently disabled, upon reasonable written notice to the Studio/Club Owner of the death or disability, either I or my estate may cancel this agreement and receive a pro-rata refund for my unused sessions/classes. Cancellation and Refund: To cancel this agreement, the client must notify the Club/Studio Management in writing. FINAL SALE - NO REFUND; if for any reason the participant cannot complete the program, you may transfer the program to another suitable candidate who will benefit from the program. I, the undersigned, waive and release the Club/Studio and its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from any and all claims in any way connected with my participation. This agreement is binding on my heirs and executors. I understand that ALL aspects of this wavier apply to any children that I bring with me to any of the classes/programs/events/meetings or gatherings offered or facilitiated by Club/Studio. I acknowledge that I am the legal guardian of the child(ren) listed on this form (if any). By signing this document, I acknowledge that I have read or heard this document in its entirety and that I fully understand it. I have asked any questions that may have occurred to me and have been answered to my satisfaction. A legal guardian/parent must sign for any participants under the age of 18 years. Your typed signature below will be considered identical to your actual signature if this form is submitted electronically.

Date Signed: *

Please remember to bring your own water bottles,and clean INDOOR running/fitness shoes with non-marking soles. Absolutely no outdoor shoes. You may go barefoot at your own risk and/or if the class is required to be conducted barefoot (e.g. yoga, stretching, martial arts or dance or fitness classes).

How did you hear about us? *