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 an opportunity for relaxation. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly.

I assume full responsibility for any and all damages, which may incur through participation.

Zumba is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice Zumba and participation is at my own risk.

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

By my signature below, I certify that I am physically able to practice Zumba and do hereby agree that Ekrem Malkoc is not responsible or liable to me for any injury, accident, damage to health or loss of personal property. I do hereby release Ekrem Malkoc from any claim or cause of action which may have occurred as a result of any medical problem known or unknown which I have knowledge presently or in the future. I verify no promises or guarantees, other than those written in this agreement or were made to me by Ekrem Malkoc. I agree to follow the instructional guidelines presented by Ekrem Malkoc.

I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature/confirmation serves as complete and unconditional release of all liability to the greatest extent allowed 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: