Forms | Earth & Elevate

Earth & Elevate Liability Waiver

First Name

Last Name

Date of Birth

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EARTH & ELEVATE MOVEMENT STUDIO, LLC CLIENT’S REPRESENTATIONS AND WARRANTIES I hereby voluntarily agree to, personally or on behalf of the minor child named above to participate in individual and group fitness classes designed and administered by Earth & Elevate Movement Studio, LLC and its authorized agents, employees and contractors (individually and collectively, “Earth & Elevate Movement Studio”). If signing on behalf of a Minor, I understand that all references to “I” and “my” in the sections below are referring to the Minor. I hereby declare myself physically and mentally sound and suffering from no condition, injury, impairment, disease, infirmity, or other illness that would prevent my participation in the Classes. I acknowledge Earth & Elevate has recommended that I obtain a physician’s approval prior to my participation in the Classes, and that I further obtain physician’s approval with respect to the continuation of my participation in the Classes if, at any time, I suffer any adverse change in my physical or mental condition. I further acknowledge that I have either had a physical examination and have been granted permission by my physician to participate in the Classes, or I have elected to participate in the Classes without my physician’s approval. I further acknowledge that it is my responsibility to keep abreast of any changes or deterioration in my physical condition. I acknowledge and understand that the instructors and other personnel of Earth & Elevate are not trained medical professionals and that any information provided to me by Earth & Elevate neither constitutes nor serves as a substitute for medical advice. I further acknowledge that I, in my sole discretion, may disclose to Earth & Elevate the existence of an illness, injury, impairment, disease, infirmity, or other condition that may prevent, hamper, or otherwise affect my participation in the Classes, but that Earth & Elevate is not qualified to determine if and how my participation in the Classes will affect any such illness, injury, impairment, disease, infirmity or other condition, whether positively or negatively. I acknowledge and agree that I will be engaging in activities that may pose inherent risks, including but not limited to, bodily injury and death. Additionally, there may be other risks not known or not reasonably foreseeable at this time. I acknowledge our agreement that I may not bring a lawsuit or claim of any kind against Earth & Elevate Movement Studio, LLC and its members, agents, employees, contractors, officers, managers, representatives, successors, assigns, subsidiaries and/or affiliates for any injuries and/or property damage referenced in this document, either on my own behalf of on behalf of your minor child or legal ward. If I should bring such a lawsuit or claim in violation of this agreement, I agree that I shall be liable to any defending party for any and all reasonable attorneys’ fees and expenses that may be incurred in defending against such claims. I represent and warrant that all of the representations made by me herein are truthful and accurate. I have had the opportunity to ask questions regarding the representations set forth in this document, and if I have asked any such questions, Earth & Elevate has answered the same to my satisfaction.

I declare that the info I’ve provided is accurate & complete

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