Birthday

MM

DD

YYYY

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Name

First Name

Last Name

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Phone

(###)

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What services are you interested in?

Private Session

Duet Session

Pre/Post Natal

Small Group Class

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LIABILITY WAIVER - In consideration of the services to be rendered by Beka Rendell (“Instructor”), including Pilates instruction, access to and utilization of Pilates, fitness and exercise equipment and participation in the activities and programs offered by Instructor, at any given facility as determined by Instructor, I do hereby waive, release, and forever discharge Instructor and any owner or operator of the facility in which Instructor is providing services from all responsibilities or liability from injuries or damages resulting from my participation in the above mentioned activities. I understand and am aware that exercise is a potentially hazardous activity. I also understand that fitness activities involve risk of injury and even death, and I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I expressly assume and accept all risks. I hereby release and agree to hold Instructor and the facility where classes and sessions are held harmless from any causes of action, claims, demands, damages, costs, expenses and compensation for damage to myself that may be caused by any act, or failure to act, or that may otherwise arise in any way with any services received. I understand that this release discharges the aforementioned from any liability with respect to bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received. This liability waiver and release extends to all owners, partners and employees.

I have read, fully understood and voluntarily agree

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MEDICAL CLEARANCE – We recommend you consult with a physician before starting this or any exercise program. If you experience any pain or discomfort during the course of the program, stop exercising immediately and seek medical attention. Pre natal and post natal clients must consult with their physician and have received verbal clearance to perform physical exercise.

I have read, fully understood and voluntarily agree

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TERMS & CONDITIONS – Private sessions, duets and classes are 50 minutes unless otherwise noted by the instructor or on the schedule. Private and Duet sessions require a cancellation notice that is received by e-mail or text within 24 hours from the appointment time. Group classes require a 48-hour cancellation notice. If you do not show or do not cancel or reschedule your class/session within the cancellation period, you will be charged the full rate. All sessions and packages are non-transferable and non-refundable. Packages are valid for 90 days from the date of purchase.

I have read, fully understood and voluntarily agree

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COVID-19 DISCLAIMER – I acknowledge that Beka Rendell and all practitioners at the facility where services are rendered adhere to the CDC recommendations of preventative measures to reduce the spread of the COVID-19 virus to the best of their abilities, including but not limited to social distancing, face coverings and disinfecting. I acknowledge the contagious nature of the COVID-19 virus and that no guarantee exists regarding whether or not I may contract COVID-19. I understand that the risk of becoming exposed to and/or infected by the COVID-19 virus may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff and other clients. I acknowledge that I increase my risk of exposure to COVID-19 by participating in services rendered. I acknowledge that I must comply with all set procedures to reduce the spread while in attendance.

I have read, fully understood and voluntarily agree

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ELECTRONIC SIGNATURE CONSENT – By checking this box and signing below, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use electronic signature with Purpose Pilates for any documents will continue until such time you notify us in writing that you no longer wish to use an electronic signature. There’s no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

I have read, fully understood and voluntarily agree