REGISTRATION FORM

6-8-10 Week Programs

Participant Full Name *

Email *

Participant Date of birth (required for adult age confirmation) *

Primary Contact Phone *

Address

City

Postal code

Emergency Contact First Name *

Emergency Contact Phone Number *

Carefully describe the class type you are registering for below (be sure to view the website for details)!

LIABILITY WAIVER AND AGREEMENT TO PARTICIPATE IN PHYSICAL ACTIVITY: Adult Signature Required (Parent or Caregiver/Guardian Required to sign for minors)*This field is required. Liability Wavier; please read carefully. Glossary: "Club/Studio" refers to South Asian Arts Movement & The Balance Code Yoga & Wellness Ltd. and The Confidence Coach. Assumption of Risk of Injury and Wavier of Claims: I assume all risks of injury and waive all rights to pursue monetary damages or any other relief of any kind as a result of anything occurring at or near the Club/Studio location or any other venue used by the Club/Studio or its employees, officers, directors or other representatives (including but not limited to dance and/or fitness instructors and/or personal trainers and/or artists or any kind of facilitators managed by the Club/Studio and/or contractors of any type). In the event I am injured while on a property the Club/Studio uses to conduct classes, performances, or workshops, I will hold harmless the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from all claims of any sort for damages or relief, including but not limited to claims for contribution. I acknowledge there is possible danger connected with any physical activity (including the dangers of physical injury and death) and knowingly and voluntarily waive my right to make a legal or equitable claim of any sort against the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from all claims of any sort for damages or for other relief, including but not limited to claims for contribution. This assumption of risk and wavier of liability applies to my family members, successors, heirs, and assigns. Physical Condition and No Medical Advice: I represent that I am in good physical condition and have no medical reason or impairment that might prevent me from my participation or intended use of the Club/Studio and the services offered. I acknowledge that the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns will not and cannot provide me medical advice relating to my physical condition and ability to use the facilities/participate in programs/classes. If I have any health or medical concerns now or after joining a class, I will discuss them with my doctor before attending & participating in any classes or using the Club/Studio"s services. Death/Disability Clause: If I die or become totally or permanently disabled, upon reasonable written notice to the Studio/Club Owner of the death or disability, either I or my estate may cancel this agreement and receive a pro-rata refund for my unused sessions/classes. Cancellation and Refund: To cancel this agreement, the client must notify the Club/Studio Management in writing. A refund of unused classes, MINUS a 20% administrative charge, can be provided upon withdrawal from any program EXCEPT in the cases where the fees paid or program purchased were purchased on sale or discounted - in this case all fee are FINAL SALE - no refunds will be issued. I, the undersigned, waive and release the Club/Studio and its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from any and all claims in any way connected with my participation. This agreement is binding on my heirs and executors. I understand that ALL aspects of this wavier apply to any children that I bring with me to any of the classes/programs/events/meetings or gatherings offered by Club/Studio. I acknowledge that I am the legal guardian of the child(ren) listed on this form (if any). By signing this document, I acknowledge that I have read or heard this document in its entirety and that I fully understand it. I have asked any questions that may have occurred to me and have been answered to my satisfaction. A legal guardian/parent must sign for any participants under the age of 18 years. Your typed signature below will be considered identical to your actual signature if this form is submitted electronically; your electronic signature will be deemed identical to your actual signature. *

PLEASE READ AND INDICATE YOUR UNDERSTANDING AND AGREEMENT*This field is required. PLEASE NOTE: The studio does not provide make-up classes for ANY registered programs. Online classes will be provided in the case of a health pandemic or other emergency situation. Students may also join online via zoom in case they are sick but still able to do the class.

Yes, I understand.

No, this does not make sense to me.

PHOTO AND VIDEO CONSENT AND RELEASE*This field is required. Please provide your consent to allow The Balance Code Yoga & Wellness Ltd.to use photos/video taken in class and at performances, that may have you/your child in them, for promotional and advertising purposes. *

I consent.

I do not consent.

How did you hear about us? (Google search, Facebook, Referred by friend, etc.) *

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