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Acro Liability Waiver

 I HEREBY AGREE TO THE FOLLOWING:

1. I am participating in the Classes, Workshops, Intensives, Immersions, Conference, Festival, or Retreats offered by Daisy Steinfort, Kate Burkett, & hosting location, during which I will receive information and instruction about yoga, Thai massage, and acrobatics.  I recognize that yoga, Thai massage, and acrobatics require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to any practice of physical exertion and regarding my participation in any or all offerings by Daisy Steinfort, Kate Burkett & hosting location. I represent, verify, and warrant that I am physically fit and that I have no medical condition that would prevent my full participation in any or all Best Beginner AcroYoga offerings.

3. In further consideration of being permitted to participate in any or all Best Beginner Acro Yoga or Seeds of Vibrance offerings, I knowingly, voluntarily and expressly waive any claim I may have against Daisy Steinfort, Kate Burkett, the hosting location, and any staff members or assistants, for injury or damages that I may sustain as a result of participating in yoga, Thai massage or acrobatics.

4. I further hereby indemnify and hold harmless Daisy Steinfort, Kate Burkett, & hosting location and assigns from any and all damages, liabilities, costs and expenses, including reasonable attorneys’ fees, arising out of or relating to any claim by a third party resulting from my practice or instruction in the field of yoga, Thai massage, or acrobatics.

5. I, my heirs or legal representatives forever release waive, discharge and covenant Daisy Steinfort, Kate Burkett, hosting location, and assigns for any injury or death caused by their negligence or other acts.

6. Photograph/Likeness/Videotape Release: As the enrolled participant and/or the parent/guardian of the enrolled participant, I authorize Daisy Steinfort, Kate Burkett and/or its representative, agent, or employee to photograph and/or videotape and use any photograph/likeness of me or my minor child for any purpose, including publicity, choreographic archives, promotional materials and/or any other reason deemed appropriate by Daisy Steinfort or Kate Burkett. 

I have read the above release and waiver of liability and fully understand its contents. By signing below, I fully and voluntarily agree to the terms and conditions stated above.

Today's Date: December 13, 2018

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Parent or Guardian's Email Address

Email*

Confirm Email*
Stay in the loop for more Acro classes & events!
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
How did you hear about this class?*

If you were referred by a friend, what is their name?

What are you looking to gain from AcroYoga, AcroFit, Thai & Fly &/or Thai Body Vibes classes?

Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, 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 an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is 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.


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