Zumba Class Registration Form and Liability Waiver

First Name*
Last Name*
Are you 18 years or older?*

YESNO
Email (Parent/Guardian's if under 18)*
example@example.com
Phone (Parent/Guardian's if under 18)*

Country CodePhone Number
I agree to be contacted by Ekrem Malkoc regarding Zumba class related announcement and information using my contact information.*

YESNO

Zumba Class

Liability Waiver

I understand that Zumba includes physical movements as well as opportunities for relaxation. As with any physical activity, there is always a risk of injury, including serious or disabling injury, which cannot be fully eliminated. If I feel unwell or experience pain, I will stop immediately and speak to the instructor.

I assume full responsibility for any and all damages or injuries that may occur through my participation.

Zumba is not recommended and may be unsafe for individuals with certain medical conditions. By signing, I affirm that a licensed physician has confirmed my good health and physical condition to take part in this fitness program. I will also inform the instructor of any medical conditions or physical limitations before class. If I am pregnant, become pregnant, or am post-natal or post-surgical, my signature confirms that I have my physician’s approval to participate. I understand that I am solely responsible for deciding whether to take part in Zumba and that participation is entirely at my own risk.

I hereby agree to irrevocably release and waive any claims that I have now or may have in the future against the certified Zumba Instructor, Ekrem Malkoc.

By my signature below, I certify that I am physically able to participate in Zumba and agree that Ekrem Malkoc is not responsible or liable for any injury, accident, health-related issue, or loss of personal property. I release Ekrem Malkoc from any claim or cause of action arising from medical conditions or problems, whether known or unknown, that may occur now or in the future. I acknowledge that no promises or guarantees have been made to me other than those written in this agreement. I agree to follow the instructional guidance provided by Ekrem Malkoc.

I have read, fully understand, and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and acknowledge that my signature/confirmation serves as a complete and unconditional release of all liability to the fullest extent permitted by law in the United Kingdom.
AGREE (Liability Waiver)*

YesNo

Photo/Video Release I hereby grant Ekrem Malkoc permission to use my likeness in a photograph, video, or other digital media (“photo”) in web- based publications and online social media (e.g. Instagram, Facebook, Twitter) without payment or other consideration. I hereby irrevocably authorize Ekrem Malkoc to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge Ekrem Malkoc from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO/VIDEO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES.
AGREE (Photo/Video Release)*

YesNo

Date*

DayMonthYear
Date
If under 18, A PARENT/GUARDIAN MUST SIGN*

Clear
Name and Surname of the parent/guardian (if applicable)
Should be Empty: