Zumba Class Liability Waiver

First Name*
Last Name*
Email (Parent/Guardian's if under 18)*
example@example.com
Phone Number*

Country codeMobile phone
Are you 18 years or older?

YESNO
Date of birth

MonthDayYear
Date

Emergency contact *

First NameLast Name
Emergency contact number *

Area CodePhone Number

Zumba Class Liability Waiver I understand that Zumba includes physical movements 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.

The class is designed for 18+ attendance due to the nature of some of the movements used in the routines however exceptions can be made at the instructor's discretion.

I assume full responsibility for any injury, 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 physical activities. 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. By my signature below, I certify that I am physically able to practice Zumba and do hereby agree that the instructor is not responsible or liable to me for any injury, accident, damage to health or loss of personal property.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 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 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. if I do not wish to appear in any promotional material I will let the instructor know in advance and click NO below. 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

Which event are you registering for:
If under 18, A PARENT/GUARDIAN MUST SIGN*

Clear
Date*

DayMonthYear
Date
Name and Surname of the parent/guardian (if applicable)
Please make payments via revolut on

https://revolut.me/miapedrozumba

PayPal:

paypal.me/epedrosmt

Or bank payment to

Barclays Bank

Emilia Pedro

Acc number 30497711

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