The Stillness Space Liability Waiver

The Stillness Space Liability Waiver

Please complete this form to participate in Pilates classes and acknowledge the waiver of liability.
Participant Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (00)00-000-000.
Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any existing medical conditions or injuries that may affect your participation? If yes, please specify.
Which class(es) are you participating in?
Do you have any medical conditions that may affect your participation?
If you selected yes to any of the above, please provide details:
Are you currently taking any medication that may affect exercise participation?
If yes:
Are you pregnant or have given birth recently?
If so, when or how many weeks?
Is there anything else you would like your instructor to know to help support your experience? Goals, requests to see in class, injuries etc.
Participant Declaration

I understand that participation in services provided by The Stillness Space may include Pilates, movement-based exercise, stretching, mobility work, strength and stability training, breathwork, meditation, mindfulness practices, workshops, wellness education, online programs, and related activities.

I understand that participation may involve physical exertion and carries inherent risks including but not limited to muscle soreness, strains, sprains, aggravation of existing conditions, falls, injury, dizziness, and emotional discomfort that may occasionally arise during mindfulness or meditation practices.

I voluntarily choose to participate and accept these risks.
Informed Consent

I understand that participation in Pilates, meditation, mindfulness and wellness activities may involve physical exertion and carries inherent risks including muscle soreness, strains, falls, aggravation of existing conditions, injury, and occasional emotional discomfort during mindfulness or meditation practices.

Scope of Practice

The Stillness Space provides Pilates instruction, movement education, mindfulness practices, meditation services, and wellness education only. The Stillness Space does not provide medical, physiotherapy, psychological, counselling, rehabilitation, or healthcare services.

Assumption of Risk & Liability Waiver

I voluntarily assume the risks associated with participation and acknowledge that participation is undertaken at my own risk. To the fullest extent permitted by law, I release The Stillness Space, its owners, instructors, employees, and contractors from liability arising from my participation except where liability cannot legally be excluded.
Photography Consent
REQUIRED AGREEMENT CHECKBOXES
Acknowledgement & Agreement

By signing below, I confirm that I have read and understood this document, disclosed relevant health information, understand the risks involved, and agree to participate under the terms outlined by The Stillness Space.
Signature (Please sign below to confirm your agreement to the waiver above)
Date Signed

MonthDayYear
Date
Additional Comments (optional)
Should be Empty: