This form covers all private and semi-private sessions, classes, and workshops offered by Lauren Jessica Romphf and/or Embodied Life Pilates and Movement Centre.

That I am participating in Pilates, movement practices, exercise, and/or other workshops offered by Lauren Jessica Romphf and/or Embodied Life Pilates and Movement Centre, during which I receive information and instruction about healthy and safe practice. I recognize that these classes and workshops may require physical exertion, which may be strenuous and could result in physical injury, and I am fully aware of the risks and hazards involved.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in classes, workshops, and movement sessions. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in these private sessions, classes, workshops and movement sessions.

I understand that classes, sessions, and workshops may involve hands-on instruction and physical adjustments during the course of the class, session, or workshop. If I prefer not to receive physical contact, I will communicate this with Lauren Jessica Romphf prior to class, session, or workshop.

I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program or which occur on the property (635 Commissioners Rd W, London, ON N6K 1B6) and premises. I agree to inform Lauren Jessica Romphf and/or Embodied Life Pilates and Movement Centre of any physical limitations, physical discomforts and/or injuries before or during classes, and I take full responsibility for nondisclosure.

In further consideration of being permitted to participate in private sessions, classes, workshops, I knowingly, voluntarily and expressly waive any claim I may have against Lauren Jessica Romphf and/or Embodied Life Pilates and Movement Centre for injury or damages that I may sustain as a result of participating in this program.

I forever release and discharge Lauren Jessica Romphf and/or Embodied Life Pilates and Movement Centre from: any damages arising from personal injuries sustained, in or about the premises. I assume full responsibility for such injuries and damages, including without limitation any claim for personal injuries resulting from and arising out of either the negligence of Lauren Jessica Romphf or the negligence of any other person.

I acknowledge and recognize that my payment for services is non-refundable and that I must cancel 18 hours before my scheduled session start time or I will be charged for that session.

I have read the above release waiver of liability and fully understand its contents. I voluntarily agree to its contents. I voluntarily agree to the terms and conditions stated above.

consent to the above terms and conditions.