The Healing Room
Please fill out the following form to help us understand your physical condition.
I acknowledge and agree that in consideration of being permitted to participate in Fitness classes organized, staged and/or operated by Shake It Off Studio (hereinafter referred to as “Shake It Off Studio”
I DO HEREBY RELEASE “Shake It Off Studio” and its directors, officers, employees, Instructors, sponsors, independent contractors and agents from all liability, and DO HEREBY WAIVE as against “Shake It Off Studio” and its directors, officers, employees, sponsors, independent contractors and agents all recourses, proceedings, claims, and causes of action of any kind whatsoever, in respect of any and all personal injuries or property losses which I may suffer arising out of or connected with my preparation for, or participation in a Fitness class notwithstanding that such injuries or losses may have been caused solely or partly by the negligence or breach of duty of “Shake It Off Studio”, or any of their directors, officers, employees, sponsors, independent contractors or agents.
I HEREBY ACKNOWLEDGE AND AGREE THAT:
Fitness classes may be dangerous, exposing participants to many risks and hazards, some of which are inherent in the very nature of a Fitness class itself, others which result from human error and negligence on the part of the persons involved in organizing, staging and/or operating the Fitness class;
I nevertheless freely and voluntarily assume all the aforesaid risks and hazards, and that, accordingly, my preparation for, and participation in Fitness classes shall be entirely at my own risk;
I have carefully read this RELE ASE and WAIVER of LI ABILI T Y AND ASSUMPTION of RISK AGREEMENT (the "Agreement"), that I fully understand same, and that I am freely and voluntarily executing same;
I clearly understand that by signing this Agreement I will be FOREVER PREVENTED FROM SUING OR OTHERWISE CLAIMING against “Shake It Off Studio”, its directors, officers, employees, sponsors, independent contractors and agents for any loss or damage connected with any property loss or personal injury that I may sustain while participating in or preparing for Zumba® Fitness and Fitness classes, whether or not such loss or injury is caused solely or partly by the negligence of “Shake It Off” or any of its directors, officers, employees, sponsors, independent contractors and/or agents;
I have been given the opportunity and have been encouraged to seek legal advice prior to signing this Agreement;
I clearly understand that Shake It Off Studio would not permit me to participate in Zumba® Fitness and Fitness classes unless I signed this RELEASE and WAIVER of LIABILITY AND ASSUMPTION of RISK AGREEMENT, that this
I clearly understand that refunds and extensions on class passes and packages will not be granted and that it is up to me to manage and maintain my own profile and account
RELEASE and WAIVER of LIABILITY AND ASSUMPTION of RISK AGREEMENT applies to Zumba® Fitness and Fitness classes whether occurring in the near or distant future, and that the terms of this Agreement have been explained to me by Shake It Off Studio or one or more of their representatives;
This RELEASE and WAIVER of LIABILITY AND ASSUMPTION of RISK AGREEMENT is binding on myself, my heirs, my executors, administrators, personal representatives and assigns;
This Agreement may be in addition to another agreement I must sign as a condition of participation in Zumba® Fitness and Fitness classes and that I am bound by the terms and conditions of both agreements; and
I agree that I am physically capable of participating in Zumba® Fitness and Fitness classes, and that I have no pre-existing conditions that would hinder my ability to participate in Zumba® Fitness and Fitness classes.
By entering Shake It Off Studio and participating in classes and activities, I hereby grant Shake It Off Studio , the irrevocable right and permission to photograph and/or record me in connection with Shake It Off Studio and to use the photograph and/or recording for promotional purposes. I waive any right to inspect or approve the use of the photograph and/or recording, and acknowledge and agree that the rights granted to this release are without compensation of any kind
This Agreement must be completed in full, initialed, dated, signed and witnessed prior to participating in any classes.
Thanks for submitting!