The Love You Club™ Participant Waiver & Intake Form 💖✨

Full Name

First NameMiddle NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Emergency Contact Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

ASSUMPTION OF RISK
Participation in fitness activities such as cardio, dance fitness, strength training, stretching, mobility, and wellness activities involves inherent physical risks including injury, soreness, falls, and aggravation of pre-existing conditions. Participant voluntarily assumes all risks.

RELEASE OF LIABILITY
Participant releases and holds harmless:

The Love You Club LLC
Markesha Payne
instructors
contractors
staff
volunteers
from liability related to participation in activities.

PERSONAL PROPERTY
The Love You Club is not responsible for lost, stolen, or damaged belongings.

Have you ever been advised by a physician not to participate in physical activity?

Do you have any injuries, medical conditions, or physical limitations we should be aware of?

Are you pregnant?

“Do you consent to photos/videos being used for social media and promotional purposes?”

“Would you like to receive updates, promotions, wellness tips, and event information from The Love You Club?”

How did you hear about The Love You Club?”

Digital Signature

Date

Agreement

The Love You Club™ Participant Waiver & Intake Form 💖✨

Participant Information

Medical Acknowledgment

Signature