Xtreme Hip Hop With Shy

Please Fill in the Form & Sign Waiver.

Thank you so much for joining 6 weeks online Xtreme Hip Hop with Shy program. Before you can get going and join one of my classes I have a very brief health questionnaire that I need you to complete openly and honestly. Know that anything you share within this form will be kept completely confidential and I’m only asking for this information to ensure I can keep you safe whilst exercising with me. If you have any concerns or questions whilst completing the form just let me know.

I have enrolled in the health and fitness program offered by Chiann-Lee Ria. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. In addition, I am fully aware of the risks and hazards connected with the participation in the physical program including, but not limited to, physical injury or even death. I hereby elect to voluntarily participate in this program knowing that the associated physical activity may be hazardous to me and/or my property.

I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, THAT MAY BE SUSTAINED BY ME, OR LOSS OR DAMAGE TO PROPERTY OWNED BY ME, AS A RESULT OF PARTICIPATION IN THIS PROGRAM.

I, the undersigned user, agree to indemnify and hold harmless, their officers, agents, and employees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to the functional training class. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in participating in an exercise program and that I am voluntarily assuming the risks. I understand that I will be solely responsible for any loss or damage, including death, I sustain while participating in this group exercise program and that by this agreement of any and all liability for such loss, damage, or death. In signing this waiver and release, I acknowledge and represent that I have read and understand the foregoing and hereby sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I hereby execute this waiver and release for valuable consideration, intending to be bound by the same.