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Contact / Registration

Interest:  Pilates, Yoga, Dance, Goals:

Exercise History:

Health History:

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Informed Consent Waiver

In consideration of being allowed to participate in any way in My Brooklyn Pilates LLC's fitness classes, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

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  • The risk of injury from activities involved in this class is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

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  • I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and,

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  • I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

 

  • I, for myself and on behalf of my heirs, assigns, personal representative and next of kin, hereby release and hold harmless My Brooklyn Pilates LLC, Jennifer DeVane, her officers, spoonsors, staff, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), with respect to all and any injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.

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I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT'S OF MINORITY AGE

(UNDER 18 AT TIME OF REGISTRATION)

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This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities to my minor child’s involvement or provision in these programs as provided above, even if arising from their negligence, to the fullest

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* There is a 24-hour cancellation policy for all sessions and group classes, except in the case of an emergency.

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