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Agreement and release of Liability 

In consideration of being allowed to participate in the personal training activities and programs of S-Williamson, LLC and to the use of its facilities, equipment, and services, in addition to the payment of any fee or charge, I do herby forever waive, release, and discharge S-Williamson, LLC and its officers, agents, employees, representatives, executors, and all others acting on their behalf, arising out of or connected with my participation in any activities, programs, or services or S-Williamson, LLC, or the use of any equipment at various sites, including home, provided by and/orrecommended by S-Williamson, LLC.

I have been informed, understand, and am aware that strength, flexibility, and aerobic exercises, including the use of circus and pole equipment, are potentially hazardous activities. I also have been informed, understand, and am aware that fitness activities involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding, and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death.

I do hereby further declare myself to be physically sound and suffering from no condition: Impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment or machinery. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in the exercise activities, programs, and use of exercise equipment. I also acknowledge that it has been recommended that I have yearly or more frequent physical examinations and consultations with my physician as to physical activity, exercise, and use of the exercise equipment. I acknowledge that I have either had a physical examination and have been given my physician’s permission to participate, or I have decided to participate in the exercise activities, programs, and use of equipment without the approval of my physician and do hereby assume all responsibility for my participation in said activities, programs, and use of equipment.

The use of alcohol and drugs is prohibited while participating in exercise activities, programs, and use of equipment.

I understand the Cirque Du Kairos, (S-Williamson, LLC) provision and maintenance of an exercise/fitness program for me does constitute an acknowledgment, representation, or indication of my physiological well-being, or medical opinion relating thereto. 

I understand and agree to any and all late cancel and no show fees. A late cancel is considered canceling a class reservation within 2 hours of the class start time. A no show is considered to be any class signed up for online that the client does not attend and does not cancel. I understand that if I choose not to sign up for class that I risk the chance it is full or canceled. Instructors can cancel any class with zero students signed up 2 hours prior to class start time. 

Due to the nature of the classes at Kairos, I understand that I will not be allowed to participate in any class if I arrive more than 10 minutes after the scheduled start time. No exceptions. 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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*
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*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
How did you hear about us?
How Did you hear about us?*
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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