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New Student / Fitness Class Waiver

Note: The interest survey at the end is optional, but will help us plan classes in the future so we greatly appreciate your input!

Release of Liability:

In signing below, I agree that Rejuvenate Massage Therapy, RaQs Fusion Bellydance, and any fitness instructors, independent contractors, owners, or employees working within Rejuvenate or RaQs Fusion are in no way responsible for the safekeeping of my personal belongings while I attend class. I understand that classes at Rejuvenate may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury, property loss, or death. I have spoken with my doctor about any concerns and have determined that I am healthy enough to attend class. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Rejuvenate/RaQs Fusion or it's instructors/independent contractors/owners/employees for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.

I Agree
 

 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information and discounts by e-mail (once a month or less)
A signed copy of this waiver will be sent to the email address you provide.
Interest Survey (NOT REQUIRED)
Please select any classes you would be interested in attending if they were offered at our studio!
Buti Yoga
Bellydance
Kids Bellydance
RaqiSa Barre
West Coast Swing
East Coast Swing
Hula Dance (Hawaiian)
Clogging
Hula Hoop
Kids Yoga
HIIT
Zumba
Yoga (Beginners/"Couch to Yogi")
Yoga (Vinyasa/All Levels)
Yin Yoga/Restorative Yoga
Yoga Sculpt

Feel free to make any other class requests here ^
Which times are best for you to attend classes?
5:30-7:30am
7:30-9:30am
12-1pm
3:30-5:30pm
5:30-7pm
after 7pm

Please make any comments about class times here ^
What days of the week are best for you?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Any other comments or requests
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*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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