Essentrics Policy Agreement Form
Effective January 1, 2024
By completing and signing this form, I acknowledge and confirm the following:
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CANCELLATIONS: I will give Lynne Loiselle at least 24 hours' notice when cancelling an in-person Essentrics class, otherwise I will be charged for the class, based on the hourly rate of my pre-paid pass or the drop-in rate if I am a drop-in client. (This does not apply to online Zoom participants.)
EXPIRY DATES: I acknowledge that pre-paid passes have an expiry date: 5 class passes will expire 2 months after purchase and 10 class passes will expire 4 months after purchase. The 2 or 4-month period will only be extended for any vacation time Lynne takes and any holidays such as Christmas and stat holidays.
HOLDS: I can ask for my 5 or 10 class pass to be put on hold in the event of a medical emergency only. The pass can be put on hold for up to 6 months, after which time it will no longer be valid (no other exceptions). I must request the hold (please do not assume that Lynne will know to do this for you). Lynne will attempt to keep a spot open for you upon your return (for in-person classes) but she cannot guarantee this.
REFUNDS: I acknowledge that all payments are final and no refunds are given.
HEALTH: I will complete all health and waiver forms requested by Lynne Loiselle and will notify Lynne Loiselle of any changes in my health status that occur after the forms have been submitted.
I have read this whole document and I accept the terms indicated above.
Client's Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
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Area Code
Phone Number
Client's Signature
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Date Signed
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Print Form
Should be Empty: