Mat Pilates Participation Waiver And Release Form

Participation Waiver And Release Form
Participant Name

First NameLast Name
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any medical conditions (e.g. injury, asthma, epilepsy….), medications, or serious allergies?
I, the undersigned, understand that in the case where I have an injury, sickness or anything else that may be affected by physical activity, I have consulted with a physician to ensure that I can take exercise classes. I recognize that it is my responsibility to notify the instructor of any serious illness or injury before every class. I accept that neither the instructor, nor the hosting facility is liable for any injury, or damages, to person or property, resulting from the taking of the class.
Participant Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: