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Plans & Pricing
HEALTH HISTORY FORM
The Fayetteville Observer
Fitness Liability Waiver
Date of Birth
Do you have a doctor’s consent to participate in physical activities?
Please specify anything we should know about. (Injury/Disability)
I declare that the info I’ve provided is accurate & complete
1. I understand that participation in any exercise program may increase the risk of injury to myself. 2. I understand that the level of my participation in the exercise program and which exercises to perform must be determined by me, in consultation with my physician, and that Dancing Without Sin®, Total Transformation Toning With Steph™, Steph’s Zumba World, ZUMBA©, Stephanie Brown Kegler, guest instructors, are not responsible for the intensity of my participation. 3. I understand that the instructors are not physicians, nurses, or emergency medical technicians, and that the instructors and Dancing Without Sin®, Total Transformation Toning With Steph™, Steph’s Zumba World, ZUMBA©, Stephanie Brown Kegler by making the exercise program available, are not undertaking any responsibility regarding my medical condition(s). If my medical condition should change, I understand that it is my responsibility to discontinue the exercise program and to immediately consult with my physician about continuing or resuming participation in this or any exercise program, classes, and or events. 4. I hereby personally assume any and all risks associated with participating in this exercise program and attending any online workouts given or sponsored by Dancing Without Sin®, Total Transformation Toning With Steph™, Steph’s Zumba World, ZUMBA©, Stephanie Brown Kegler via Zoom, Facebook, You Tube or in person at any locations . 5. I hereby release, indemnify and hold harmless Dancing Without Sin®, Total Transformation Toning With Steph™, Steph’s Zumba World, ZUMBA©, Stephanie Brown Kegler to include employees, independent instructors, and the instructors of the exercise program I have chosen to attend, from any and all claims, demands, personal injuries, costs, or expense, (including attorney’s fees) arising from or relating in any way to my participation in the exercise program. 6. Should a provision of this agreement or portion thereof be found invalid or void as against public policy by any court of competent jurisdiction, the remainder of this agreement shall nonetheless remain in full force and effect. 7. I acknowledge that I have read and understand this Waiver, Release and Indemnity Agreement and have been given the opportunity to ask any questions and have received and understand all of the information which was provided. In witness whereof, I have signed this Waiver, Release and Indemnity Agreement
Thanks for submitting!
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