New Client Waiver - Gold Line Pilates

Date

Name *

First

Last

Email *

I understand and agree to the statements below: *

Pilates is not a substitute for medical examination and/or diagnosis. It is recommended that I see a physician for any physical ailment that I may have. I understand that the Instructor does not diagnose illness, disease or any other physical or mental disorder. Likewise, the Instructor does not prescribe medical treatment or pharmaceuticals, nor does the instructor perform any physical adjustments. Because physical activity should not be performed under certain medical conditions, I affirm that I have stated all of my known medical conditions and understand that there shall be no liability on the Instructor’s part should I fail to do so.

I understand and agree to the statements below: *

In consideration of participating in “Activity” at Gold Line Pilates, I agree and acknowledge that I am fully aware that participation in the Activity involves risks and I accept all the risks of participating, even if the risks are created by the carelessness, negligence or gross negligence of a Released Party (as defined below) or anyone else. “Claims” includes but is not limited to any and all liabilities, claims, demands, legal actions, rights of actions for damages, personal injury or death in connection with participation in the Activity. “Released Party” means Gold Line Pilates or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff.

I understand and agree to the statements below: *

I am in proper physical condition to participate in the Activity, and am aware that participation could, in some circumstances, result in physical injury, serious physical injury or death.

I understand and agree to the statements below: *

I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured.

I understand and agree to the statements below: *

I agree not to sue any Released Party for Claims, even if the Claims arise from the carelessness, negligence or gross negligence of any Released Party or anyone else. I agree to indemnify (reimburse for any loss) and hold harmless each Released Party from any loss or liability (including any reasonable legal fees they may incur) defending any Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or did result from the carelessness or negligence of any Released Party or anyone else.

I understand and agree to the statements below: *

I am aware that there is no obligation for any person to provide me with medical care during the Activity. I understand and acknowledge that: a. there may be no aid stations available for the Activity. b. if medical care is rendered to me, I consent to that care if I am unable to give my consent for any reason at the time the care is rendered.

I understand and agree to the statements below: *

I grant my permission to the Released Party and any transferee or licensee or any of them, to utilize any photographs, motion pictures, videotapes, recordings and other references or records of the Activity which may depict, record or refer to me for any purpose (“Likeness”), including commercial use by the released parties, their sponsors and their licensees. This permission is for use anywhere in the world and on the Internet and for an unlimited period of time. I understand and agree that I will not be compensated or receive additional consideration for consenting to the use of my Likeness and that I will not be given a chance to receive, inspect or approve the promotional or marketing material, messages and/or content that may use my Likeness.

I understand and agree to the statements below: *

No warranties or representations have been made to me about the Activity which are not stated on this form. I understand and intend that this document act as the broadest and most inclusive assumption of risk, waiver, release of liability, agreement not to sue and indemnity.

I understand and agree to the statements below: *

I hereby acknowledge that I may be required to use an automobile to travel to and from the Activity or as part of the Activity. I hereby acknowledge that I have the authority to use such automobile and that the automobile is fully insured for use in the Activity. I accept full responsibility for the automobile and that use of the automobile in the Activity will be at my own risk.

I understand and agree to the statements below: *

If any provision of this agreement shall be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions.

I understand and agree to the statements below: *

I have fully read and understand this agreement. I am aware that by signing this agreement, I am waiving certain legal rights I or my heirs, next of kin, executors, administrators and assigns may have against the Released Party.