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barreMADE Participation Waiver

Between: (the "Participant")

-and-

barreMADE and any persons related to or associated with barreMADE, including, without limitation, all of their respective directors, officers, partners, members, employees, instructors, agents, consultants, volunteers and contractors (all of whom are collectively referred to as the “Releasees”)

RE: REGISTRATION FORM, COLLECTION OF PERSONAL INFORMATION, ASSUMPTION OF RISK, INFORMED CONSENT, RELEASE OF LIABILITY, WAIVER OF CLAIMS and INDEMNITY AGREEMENT

BY ENROLLING AS A STUDENT OF barreMADE, YOU AGREE TO BE BOUND BY THE RULES AND REGULATIONS OF barreMADE, AGREE TO RECEIVING COMMUNICATIONS FROM barreMADE AND BY EXECUTING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. PLEASE READ CAREFULLY!

 

I acknowledge, consent and agree as follows:

  1. I understand and consent to barreMade collecting and storing my personal information.
  2. I fully understand and am aware that there are inherent risks, dangers, and hazards associated with strength training, aerobic exercise, weight training, use of fitness equipment, fitness activities and barre classes (collectively the "Activities") which may take place at the premises of barreMADE (the "Premises"), or in my own home while participating in virtual classes. My use of the Premises or participation in the Activities may result in injury or illness to my person, including, but not limited to, bodily injury, disease, sprains, strains, fractures, partial and/or total paralysis, COVID-19 infection, death or other ailments that could cause serious disability, and damage to my property (collectively the "Risks"). I am aware of the Risks and that they may be caused by the negligence of the Releasees or the negligence of others, or by accidents, breaches of contract or other causes. I have full knowledge of the nature and extent of the Risks associated with the Activities and the Premise and I freely and voluntarily assume all Risks and all responsibility for any loss or damage which may arise out of or in connection with my participation in the Activities or use of the Premises, whether caused in whole or in part by the negligence of the Releasees or any other person.
  3. I am in good physical and mental health. I further acknowledge that the Releasees have encouraged me to consult with, and seek approval from, my physician prior to participating in the Activities or using the Premises. I have been given permission by my physician to participate in the Activities and to use the Premises, or I have voluntarily accepted all the risks of not consulting my physician and have decided to participate in the Activities or to use the Premises without such approval. I release the Releasees from any and all liability and claims for any injuries, disability, death or loss or damage to person or property incurred while participating in the Activities or using the Premises, such having occurred due to or in part due to any and all known or unknown medical conditions, injuries, illnesses, ailments, allergies, or medications. 
  4. I agree that, although barreMADE and the Personnel may take precautions to reduce the risks and increase the safety of the Activities, it is not possible for barreMADE or the Personnel to make the Activities completely safe. I further understand that even with the Studio's additional COVID-19 safeguards and procedures in place there is a risk of injury or illness in attending the Studio or participating in classes at the Studio. I willingly accept these risks and agree to the terms of this barreMADE Waiver even if barreMADE or any of the Personnel are found in law to be negligent or in breach of a duty of care or any other obligation to me in their conduct of any Activity.
  5. In exchange for my entitlement to use the Premises or to participate in the Activities, I hereby voluntarily release, waive, discharge, hold harmless, defend and indemnify the Releasees from and against any and all claims, actions, losses, injuries, damages, expenses, costs or relief of any nature or kind whatsoever, including but not limited to the Risks, whether in law or in equity, that I or any other person may have, suffer or incur as a result of my participation in the Activities, my use of the Premises or my presence at, in or near the Premises, due to any cause whatsoever, including, but not limited to, negligence, gross negligence, trespass, breach of contract, vicarious liability for any other person’s act or omission, or breach of any statutory or other duty of care, including any duty of care owed under the Occupiers Liability Act, O-4, RSBC 1996 (as amended) on the part of the Releasees.
  6. barreMADE occasionally takes photos during classes and events to be used in various print and online media. If you do not to the use of your likeness and image please check the box in the next section.
  7. I do not currently teach or plan to teach barre at another business on the south Vancouver Island. I understand that barre is dance based and barreMADE creates it's own choreography and sequences that are only to be used at the barreMADE studio.  

BY ENROLLING AS A STUDENT OF barreMADE, YOU AGREE TO BE BOUND BY THE RULES AND REGULATIONS OF barreMADE, AGREE TO RECEIVING COMMUNICATIONS FROM barreMADE AND BY EXECUTING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. PLEASE READ CAREFULLY!

I have had sufficient time to read and understand this Agreement and all schedules thereto and I am aware that by signing this Agreement I am voluntarily waiving certain legal rights which I or my Legal Representatives may have against the Releasees.

Dated: May 15, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Third Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Fourth Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Fifth Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Sixth Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Seventh Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Eighth Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Ninth Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Tenth Participant's Name

First Name*

Middle Name

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

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last 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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please answer the following questions:

Has your doctor ever said you have heart trouble?*
No
Yes

If yes, please state:
Do you often feel pain or have spells of severe dizziness?*
No
Yes

If yes, please state:
Has a doctor ever said your blood pressure was too high or too low?*
No
Yes

If yes, please state:
Have you had any operations in the last year?*
No
Yes

If yes, please state:
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*
No
Yes

If yes, please state:
Are you pregnant or postnatal?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain or numbness?*
No
Yes

If yes, please state:
Do you currently have any other medical conditions not previously mentioned?*
No
Yes

If yes, please state:
If you do NOT consent to the use of your likeness and image please check this box.
If you do NOT consent to physical hands on adjustments from the instructor please check this box.
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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