PIELATTES PEOPLE WAIVER OF LIABILITY
Participant Name
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First Name
Last Name
Participant Phone Number
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Participant Email
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example@example.com
Participant Pronouns (they/them she/her he/him etc.)
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Are you 16 years or older?
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YES
NO
Participant Date of Birth
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Day
-
Month
Year
Date
Participant Address
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Street Address
Street Address Line 2
City
State/Province/County
Postal / Zip Code
Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone Number
*
Emergency Contact Email
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example@example.com
Emergency Contact Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please read the following questions below and check YES to all that apply, leave unanswered if not applicable. This physical activity clearance is valid for 12 months from the date it is completed. It becomes invalid after 12 months and must be resubmitted by you to continue Pielattes People classes, it also becomes invalid if your condition changes, so that you would check YES to any of the eight questions.
Are you pregnant?
Do you lose your balance due to dizziness or do you ever lose consciousness?
Do you feel pain in your chest when you do physical activity?
In the past month, have you felt chest pain while doing physical activity?
Has your Doctor ever said that you have a heart condition and that you should only do physical activity if recommended by a Doctor?
Are you currently taking any medication/prescription drugs?
Do you have bone/joint issues that could be made worse by physical activity?
Do you know of any other reason why physical activity may be inadvisable to you?
Please state any medication you are currently taking / medical conditions / previous, recurring and/or current injuries / number of months pregnant
For Prenatal/Postnatal Clients - Have you been approved by your doctor to exercise? Please select N/A if this does not apply to you - optional
YES
NO
N/A
Are there any exercises/movements that you must avoid due to your condition/injuries if any?
ATTENTION
If you have checked YES to any of the Questions from this PAR-Q, are pregnant, or have any concerns or queries about your health before participating in any of the classes, it is not suitable for you to participate in Pielattes People classes unless a doctors note approving you are cleared for exercise has been provided to Rachel Jane Carscadden, via pielattespeople@gmail.com. Please email pielattespeople@gmail.com for further support. All pregnant clients must request a PARmed-X form by email.
PARTICIPATION AGREEMENT
Upon completion of this waiver I understand and accept that I have chosen to participate in physical activity (including pilates, dance, barre, stretching and cardio) with the optional use of equipment, that may be instructed via livestream and recorded classes, in my own personal home/space and/or classes in person in-studio. I understand and accept that the physical activity includes physical cardiovascular movements as well as the opportunity to stretch and relax. I understand and accept that all Pielattes People services are for ages 16 and above only. I understand and accept that the reaction of the heart, lung and blood vessel system to exercise cannot always be predicted with accuracy. I acknowledge and accept that there is a risk of abnormal changes in the body as a result of exercise including heart attack/death. If I experience any pain or discomfort I will immediately stop all physical activity with Pielattes People, I will consult my doctor and contact Rachel Jane Carscadden to update her on my situation. I understand that I am solely responsible for my own health and safety during Rachel Jane Carscadden's in-studio classes, livestream classes and recorded classes with Pielattes People.I will stop all physical activity with Pielattes People if I hurt myself/fall ill/need further postural corrections during classes and will contact my doctor and email Rachel Jane Carscadden if I require support with my account or exercise modifications. I am responsible for any personal injuries that may occur before, during or after any session I take with Rachel Jane Carscadden and Pielattes People. I understand and accept that instruction and advice given to me by Rachel Jane Carscadden does not take the place of medical advice. I understand and accept that, as with any exercise program, it is my responsibility to consult with a physician prior to and regarding my participation in the Activities. I represent and warrant that I am physically fit and I am able to full participate in the Activities. It is my own responsibility to decide whether to participate in the activities if pregnant or injured. I understand and accept that the activities may not be recommended or safe under certain medical conditions.In addition, I will advise Rachel Jane Carscadden of any medical conditions that I have prior to participating in the activities. I will also notify Rachel Jane Carscadden of any new/previous/recurring injuries, medical conditions and pregnancy and of any injuries, medical conditions or pregnancy developed after completion of this waiver, prior to class so that we can discuss the appropriate measures to take before allowing physical activity. I accept that it is my personal responsibility to complete the Pielattes People waiver once every 12 months from date of first waiver submission.I affirm that I alone am responsible to decide whether to participate in the Activities. I take full responsibility for any risks, injuries or damages, known or unknown, which might be incurred as a result of participating in the activities. I knowingly, voluntarily, expressly and irrevocably agree to release, waive, hold harmless and discharge any claims that I (or my child) have now, hereafter or may have against Rachel Jane Carscadden, Pielattes People, its owners, its instructors and its employees/staff from any liability, claims, actions or losses for bodily injury, property loss/damage or otherwise which arise out of my participation during in-studio and online services provided by Rachel Jane Carscadden with Pielattes People.
In-Studio Policy
I understand that by attending in-studio classes I am attesting that: 1. I am not experiencing any symptoms of COVID-19 including cough, shortness of breath, difficulty breathing, fever, chills, headache, muscle aches, sore throat, loss of taste or smell. 2. I have not been exposed to anyone with suspected/and or confirmed case of COVID-19 or variant/strain. 3. I am following the current government guidelines for my country of residence. 4. I am fully aware of the risks and hazards with respect to COVID-19 and all other communicable diseases during participation in Pielattes People classes.
PHOTO/VIDEO RELEASE
Pielattes Pepole may wish to use a photo or video of my person taken at the studio and/or during an in-person or Livestream class for promotional purposes on its website, brochures and/or social media platforms.
I agree to the above use of photos
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YES
NO
Agreement
By signing below and submitting the Pielattes People Waiver, I confirm that I have thoroughly read through this document, have answered all questions correctly and know of no known health reasons as to why I cannot participate in the exercise classes. I understand that all exercise comes with a risk of injury and in rare cases death. I understand and accept that Rachel Jane Carscadden is not liable for any persons physical and/or mental health, upon choosing to undertake physical activity with Pielattes People.
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