Privacy Policy - Please read carefully

Privacy Policy Consent

The Website and its Content is owned by Monica Costa, Monica Costa Coaching (“Company”, “we”, or “us”). The term “you” refers to the user or viewer of our Website (“Website”).

 This Privacy Policy describes how we collect, use, process and distribute your information, including Personal Data (as defined below) used to access this Website. We will not use or share your information with anyone except as described in this Privacy Policy. The use of information collected through our Website shall be limited to the purposes under this Privacy Policy, and also our Terms of Use if you’re a client or customer.

Please read this Privacy Policy carefully. We reserve the right to change this Privacy Policy on the Website at any time without notice. In the event of a material change, we will let you know via email and/or a prominent notice on our Website.

Use of any personal information or contribution that you provide to us, or which is collected by us on or through our Website or its content is governed by this Privacy Policy. By using our Website or its content, you consent to this Privacy Policy, whether or not you have read it.

 Information We May Collect

We collect personal information from you so that we can provide you with a positive experience when utilizing our Website or content. We will only collect the minimum amount of information necessary for us to fulfill our obligation to you. We may collect your:

1.   Name and an email address so we can deliver our newsletter to you - you would be affirmatively consenting to this by providing this information to us in our contact forms.

2.   Billing information including name, address and credit card information so that we can process payment to deliver our products or services to you under our contractual obligation.

3.   Name and an email address if you complete our contact form with a question. We may send you marketing emails with either your consent or if we believe we have a legitimate interest to contact you based on your contact or question.

4.   Information from you from a co-branded offer. In this case, we will make clear as to who is collecting the information and whose privacy policy applies. If both / all parties are retaining the information you provide, this will also be made clear, as will links to all privacy policies.

Please note that the information above (“Personal Data”) that you are giving to us is voluntarily, and by providing this information to us you are giving consent for us to use, collect and process this Personal Data. You are welcome to opt-out or request for us to delete your Personal Data at any point by contacting us at cemogo@gmail.com

 If you choose not to provide us with certain Personal Data, you may not be able to participate in certain aspects of our Website or Content.

 Other Information We May Collect

 1.   Anonymous Data Collection and Use

To maintain our Website’s high quality, we may use your IP address to help diagnose problems with our server and to administer the Website by identifying which areas of the Website are most heavily used, and to display content according to your preferences. Your IP address is the number assigned to computers connected to the Internet. This is essentially "traffic data" which cannot personally identify you but is helpful to us for marketing purposes and for improving our services. Traffic data collection does not follow a user’s activities on any other websites in any way. Anonymous traffic data may also be shared with business partners and advertisers on an aggregate basis.

 2.   Use of "Cookies"

We may use the standard "cookies" feature of major web browsers. We do not set any personally identifiable information in cookies, nor do we employ any data-capture mechanisms on our Website other than cookies. You may choose to disable cookies through your own web browser’s settings. However, disabling this function may diminish your experience on our Website and some features may not work as intended.

 What We Do with Information We Collect

 1.   Contact You.

 We may contact you with information that you provide to us based on these lawful grounds for processing:

a)  Consent. We may contact you if you give us your clear, unambiguous, affirmative consent to contact you.

b)  Contract. We will contact you under our contractual obligation to deliver goods or services you purchase from us.

c)  Legitimate Interest. We may contact you if we feel you have a legitimate interest in hearing from us. For example, if you sign up for a webinar, we may send you marketing emails based on the content of that webinar. You will always have the option to opt out of any of our emails.

 2.       Process Payments.

We will use the Personal Data you give to us in order to process your payment for the purchase of goods or services under a contract. We only use third party payment processors that take the utmost care in securing data and comply with the GDPR.

 3.       Targeted Social Media Advertisements.

We may use the data you provide to us to run social media advertisements and / or create look-alike audiences for advertisements.

4.       Share with Third Parties.

We may share your information with trusted third parties such as our newsletter provider in order to contact you via email, or our merchant accounts to process payments, and Google / social media accounts in order to run advertisements and our affiliates.

 Viewing by Others

Note that whenever you voluntarily make your Personal Data available for viewing by others online through this Website or its content, it may be seen, collected and used by others, and therefore, we cannot be responsible for any unauthorized or improper use of the information that you voluntarily share (i.e., sharing a comment on a blog post, posting in a Facebook group that we manage, sharing details on a group coaching call, etc.).

 Submission, Storage, Sharing and Transferring of Personal Data

Personal Data that you provide to us is stored internally or through a data management system. Your Personal Data will only be accessed by those who help to obtain, manage, or store that information, or who have a legitimate need to know such Personal Data (i.e., our hosting provider, newsletter provider, payment processors or team members).

 It is important to note that we may transfer data internationally. For users in the European Union, please be aware that we transfer Personal Data outside of the European Union. By using our Website and providing us with your Personal Data, you consent to these transfers in accordance with this Privacy Policy.

Data Retention

We retain your Personal Data for the minimum amount of time necessary to provide you with the information and / or services that you requested from us. We may include certain Personal Data for longer periods of time if it’s necessary for legal, contractual, and accounting obligations.

Confidentiality

We aim to keep the Personal Data that you share with us confidential. Please note that we may disclose such information if required to do so by law or in the good-faith belief that: (1) such action is necessary to protect and defend our property or rights or those of our users or licensees, (2) to act as immediately necessary in order to protect the personal safety or rights of our users or the public, or (3) to investigate or respond to any real or perceived violation of this Privacy Policy or of our Website Disclaimer, Terms and Conditions, or any other Terms of Use or agreement with us.

 Passwords

To use certain features of the Website or its content, you may need a username and password. You are responsible for maintaining the confidentiality of the username and password, and you are responsible for all activities, whether by you or by others, that occur under your username or password and within your account. We cannot and will not be liable for any loss or damage arising from your failure to protect your username, password or account information. If you share your username or password with others, they may be able to obtain access to your Personal Data at your own risk.

 You agree to notify us immediately of any unauthorized or improper use of your username or password or any other breach of security. To help protect against unauthorized or improper use, make sure that you log out at the end of each session requiring your username and password.

 We will use our best efforts to keep your username and password(s) private and will not otherwise share your password(s) without your consent, except as necessary when the law requires it or in the good faith belief that such action is necessary, particularly when disclosure is necessary to identify, contact or bring legal action against someone who may be causing injury to others or interfering with our rights or property.

 How You Can Access, Update or Delete Your Personal Data

You have the right to:

1.   Request information about how your Personal Data is being used and request a copy of what Personal Data we use.

2.   Restrict processing if you think the Personal Data is not accurate, unlawful, or no longer needed.

3.   Rectify or erase Personal Data and receive confirmation of the rectification or erasure. (You have the “right to be forgotten”).

4.   Withdraw your consent at any time to the processing of your Personal Data.

5.   Lodge a complaint with a supervisory authority if you feel we are using your Personal Data unlawfully.

6.   Receive Personal Data portability and transference to another controller without our hinderance.

7.   Object to our use of your Personal Data.

8.   Not be subject to an automated decision based solely on automatic processing, including profiling, which legally or significantly affects you.

 Unsubscribe

You may unsubscribe from our e-newsletters or updates at any time through the unsubscribe link at the footer of all email communications. If you have questions or are experiencing problems unsubscribing, please contact us at cemogo@gmail.com

 Security

We take commercially reasonable steps to protect your Personal Data from misuse, disclosure, or unauthorized access. We only share your Personal Data with trusted third parties who use the same level of care in processing your Personal Data as we do. That being said; we cannot guarantee that your Personal Data will always be secure due to technology or security breaches. Should there be a data breach of which we are aware, we will inform you immediately.

Anti-Spam Policy

We have a no spam policy and provide you with the ability to opt-out of our communications by selecting the unsubscribe link at the footer of all e-mails. We have taken the necessary steps to ensure that we are compliant with the CASL (Canada’s Anti-Spam Legislation) and CAN-SPAM Act of 2003 by never sending out misleading information. We will not sell, rent or share your email address.

Third Party Websites

We may link to other websites on our Website. We have no responsibility or liability for the content and activities of any other individual, company or entity whose website or materials may be linked to our Website or its content, and thus we cannot be held liable for the privacy of the information on their website or that you voluntarily share with their website. Please review their privacy policies for guidelines as to how they respectively store, use and protect the privacy of your Personal Data.

 Children’s Online Privacy Protection Act Compliance

We do not collect any information from anyone under 18 years of age in compliance with COPPA (Children’s Online Privacy Protection Act) and the GDPR (General Data Protection Regulation of the EU). Our Website and its content is directed to individuals who are at least 18 years old or older.

 Notification of Changes

We may use your Personal Data, such as your contact information, to inform you of changes to the Website or its content, or, if requested, to send you additional information about us. We reserve the right, at our sole discretion, to change, modify or otherwise alter our Website, its content and this Privacy Policy at any time. Such changes and/or modifications shall become effective immediately upon posting our updated Privacy Policy. Please review this Privacy Policy periodically. Continued use of any of information obtained through or on the Website or its content following the posting of changes and/or modifications constituted acceptance of the revised Privacy Policy. Should there be a material change to our Privacy Policy, we will contact you via email or by a prominent note on our Website.

 Data Controllers and Processors

We are the data controllers as we are collecting and using your Personal Data. We use trusted third parties as our data processors for technical and organizational purposes, including for payments and email marketing. We use reasonable efforts to make sure our data processors are GDPR- compliant.

If you have any questions about this Privacy Policy, please contact us at cemogo@gmail.com 25 Beaver St S., Thornbury, ON N0H 2P0

 

Last Updated: 05/28/2022


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25 Beaver St. S.

Thornbury, ON N0H 2P0

416-891-4541 | cemogo@gmail.com




Review Monica Costa Coaching Privacy Policy

I UNDERSTAND AND AGREE that there is potential risk for injury involved in any form of physical activity and movement in the participation in programs that involve physical activity. I further understand and agree that participating in a resistance training workout and/or program; Yoga, Skiing, SUP (Stand Up Paddleboarding), SUP Yoga and/or any other paddle-sport (“THE ACTIVITIES”) are potentially dangerous activities. Bumps, bruises, scrapes, scratches, and soreness are commonplace, and most participants will encounter this sort of minor injury from time to time. More serious injuries are possible, including sprains, strains, twists, cramps, and injuries of similar magnitude. The possibility of more serious injury exists, including fractured bones, broken bones, torn ligaments, though most participants do not encounter such serious injuries. There remains, despite safety precautions, the remote possibility of crippling or death.

I am aware that THE ACTIVITIES involve many risks, dangers and hazards which may include but are not limited to:

  • personal injury and/or death
  • travel to remote areas without access to immediate medical facilities or treatment changing weather conditions
  • interactions or encounters with wildlife
  • equipment malfunctions negligence of other participants or guides
  • consumption of alcohol
  • becoming lost or separated from guides or other participants; and the failure to remain within designated areas.

I FREELY ACCEPT AND FULLY ACKNOWLEDGE all such risks, dangers, and hazards, resulting from my participation in THE ACTIVITIES and any event hosted or sponsored by Monica Costa, Monica Costa Coaching.

I am also aware that I should discuss my participation in the ACTIVITIES with my physician to determine the effect on my current health.

It is my right and responsibility as a participant to immediately remove myself from participation in THE ACTIVITIES and notify the nearest trainer/coach/official, if at any time I sense any unusual hazard or unsafe condition or if I feel that I am physically, emotionally, or mentally unfit for continued participation in the program.

I have read and understand the above statement of risk. I assume responsibility for my own safety, and I understand and accept the risks involved with my participation in THE ACTIVITIES.

In consideration of being a participant in Breathwork at MONICA COSTA, MONICA COSTA COACHING, the undersigned, hereby acknowledge, understand, and expressly agree as to the following:

(1) Breathwork can result in intense physical and emotional release. Therefore, it is not advised for persons with:

●      a history of cardiovascular disease, including angina or heart attack, high blood pressure, use of a pace-maker, glaucoma, retinal detachment, osteoporosis, significant recent physical injuries or surgery.

●      mental illness or seizure disorders or for persons using major medications. It is also unsuitable for anyone with a personal or family history of aneurysms. Pregnant women are advised against practicing Breathwork without first consulting and getting approval from their primary care physician. Persons with asthma should bring their inhaler and consult with their primary care physician and the Breathwork class facilitator. This work is deeply experiential. It may involve intense and energetic emotional release.

(2) On behalf of myself, my spouse, my minor children, wards, relatives or other persons under my care, my parents, next of kin, my heirs, assigns, agents, personal representatives and estate (hereinafter collectively “RELEASING PARTIES”), I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS MONICA COSTA, MONICA COSTA COACHING and its employees, agents, representatives, team members, as well as its owners, principals, employees, agents and representatives (hereafter collectively “THE RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, whether physical, mental, psychological or emotional, or ANY LOSS or DAMAGE to PERSON or PROPERTY, of any kind, to the fullest extent permitted by law.

(3) To the fullest extent allowed by law, I agree to defend, indemnify, and hold harmless THE RELEASEES for all costs and expenses, including but not limited to all legal fees incurred by THE RELEASEES in defending any claim brought against any or all of THE RELEASEES by any of the RELEASING PARTIES.

(4) I understand that there exists a risk of physical, mental, psychological, or emotional injury &/or death from online or in person classes, programs, sessions, events or trainings in Mindset, Breathwork, Movement - Yoga, Ski, SUP, SUP Yoga (hereinafter collectively “THE ACTIVITIES”), and although personal discipline or compliance with the guidance of THE RELEASEES may reduce this risk, the risk of such injury nevertheless does exist. I fully acknowledge that I am voluntarily participating in THE ACTIVITIES with knowledge of the danger involved, and I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation.

(5) THE RELEASEES takes the Coronavirus (COVID-19) very seriously and has put in place preventative measures to reduce the spread of COVID-19; however, THE RELEASEES cannot guarantee that you will not become infected with COVID-19. Furthermore, attending THE ACTIVITIES with THE RELEASEES could increase your risk, your family members, and/or your guests of contracting COVID-19.

(6) I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk I may be exposed to or infected by COVID-19 by THE ACTIVITIES with THE RELEASEES, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 while attending classes, trainings, or programs with THE RELEASEES may result from the actions, omissions, or negligence of myself and others, including, but not limited to, THE RELEASEES employees, volunteers, and program participants and their families and whether a COVID-19 infection occurs before, during, or after participation in any Breathwork, training, sport fitness, movement, or program.

(7) By signing this document and/or checking the box below, enrolling online, and/or attending in person classes, programs, sessions, events, activities, trainings and other programs with THE RELEASEES, to the extent allowed by applicable law, you voluntarily agree, on behalf of yourself, your heirs, personal representatives and/or assigns, and any minor child you may enroll: (a) to assume all of the foregoing risks related to COVID-19 and accept sole responsibility for any COVID-19 related injury, illness, damage, loss, claim, liability, or expense of any kind (including, but not limited to, personal injury, disability, and/or death) that may occur to you or your family members in connection with THE RELEASEES or as a result of participation with THE RELEASEES services and (b) covenant not to sue THE RELEASEES for the classes, programs, trainings or services, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto based on the actions, omissions, or negligence of THE RELEASEES, whether a COVID-19 infection occurs before, during, or after participating in any with THE RELEASEES classes, programs, trainings or services.

(8) I agree to comply with the stated and customary guidance and norms of participation in THE ACTIVITIES. If; however, I observe any unusual hazard during my presence or participation, I will immediately remove myself from participation in THE ACTIVITIES and bring such to the attention of the nearest official forthwith.

(9) I know, understand, and acknowledge that THE RELEASEES are NOT physicians, psychologists, therapists, or healthcare professionals, and THE ACTIVITIES being offered are NOT intended to treat or diagnose, and does NOT include treatment for or diagnosis of, any illnesses, disease, or disorders, whether physical, mental, psychological, or emotional.

(10) I represent that I am in good health physically, mentally, psychologically, and emotionally, and fully understand and acknowledge that if I were not in such good health, I would not be permitted to partake in THE ACTIVITIES. As such, my promise, representation, and certification that I am in good health in each of the above-enumerated ways constitutes a material term upon which THE RELEASEES are relying in permitting me to partake in THE ACTIVITIES.

(11) If I am pregnant or become pregnant or am post-natal, I will not participate in THE ACTIVITIES without first discussing the risks with my doctor, and I will only participate in THE ACTIVITIES if I have my doctor’s full approval. I will not hold the RELEASED PARTIES responsible for any injuries to my pregnancy caused in part or in whole by my failure to follow my doctor’s recommendation.

(12) To the fullest extent allowed by law and in the absence of negligence, I, on behalf of myself and all RELEASING PARTIES, hereby forever unconditionally and irrevocably waive and release any and all claims I now have or may in the future have against THE RELEASEES with respect to any injury, loss or damage I suffer as a result of participating in THE ACTIVITIES or any of the future Activities in which I may participate. I understand and agree that this Release of Liability, Waiver and Assumption of Risk Agreement (hereinafter “Agreement”) extends to and includes any and all damages, injuries, and claims which I do not anticipate or known to exist and to any and all damages, injuries, or claims which may develop in the future, and I hereby expressly waive and relinquish any and all rights under any law or statute to the contrary.

(13) After being fully informed of the above, I, on my own behalf, and, to the fullest extent allowed by law, on behalf of all RELEASING PARTIES expressly agree and promise to accept and assume all of the risks inherent to and existing in connection with THE ACTIVITIES; and I voluntarily elect to participate in THE ACTIVITIES.

(14) I acknowledge, understand, and agree that this Agreement, and all of the releases, terms and conditions contained herein, shall apply with equal force and govern any future Activities in which I partake with THE RELEASEES, thus obviating the need for me to sign this Agreement each and every time I partake in THE ACTIVITIES.

(15) I understand and agree that THE RELEASEES are not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.

(16) I consent to the collection, use and disclosure, without further notice, permission or compensation to him or to her of his or her name, address (city, province), voice, statements and any photograph, film rendering or tape recording of him or her, by or on behalf of THE RELEASEES and connection with THE RELEASES in any form of publication or display including, without limitation, media, newspapers and other publications, radio and television broadcasts, film releases and interactive media worldwide.

(17) I acknowledge that my image or likenesses might be captured on film or in some digital or electronic format by persons other than THE RELEASES and fully understand that THE RELEASES have no control over such persons who capture their image or likenesses and use or display their image or likenesses for private or public purposes and that such issues or displays of their image and likenesses are beyond knowledge and/or control of THE RELEASES and that THE RELEASES shall have no liability for such activities.

(18) To the extent that any portion, clause, or aspect of this agreement is found to be invalid, void or unenforceable, all other portions, clauses or aspects of this agreement shall remain in full force and effect.

(19) I have read this release of liability and assumption of risk agreement, fully understand its terms and I have either consulted an attorney or, at my sole discretion, elected not to do so.

(20) I understand that I am providing this release as consideration, in part, for participation in THE ACTIVITIES. As such, I understand that if I wish to alter or negotiate the terms of this Agreement, I may do so by speaking with one of THE RELEASEES.   

(21) I understand that I have given up substantial rights by signing this release of liability and assumption of risk agreement and sign it freely and voluntarily without any inducement. 

(22 This RELEASE AGREEMENT shall apply to all subsequent Movement and THE ACTIVITIES programs by Monica Costa, Monica Costa Coaching. 

December 9, 2022




First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
Medical Questionnaire - please help us get to know you better. Are there any special considerations we should know prior to your participation in THE ACTIVITIES.
Do you have any allergies?*
No
Yes

If yes, please list and explain how severe.
Do you suffer from any medical condtions or long-term illness (lasting more than 6 months?)*
No
Yes

If yes, please explain:
Do you have any history with muscle, joint or back injury?*
No
Yes

If yes, please explain:
Do you have any other physical limitations or health concerns that could impact your abililty to partcipate in THE ACTIVITIES?*
No
Yes

If yes, please explain:
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Email Address

Email*

Confirm Email*
By opting in I agree to join Monica Costa, Monica Costa Coaching email list and receive email communications / newsletters sharing information about Mindset, Breathwork, Movement, Upcoming programs/workshops/classes/courses & promotions. I can opt out any time by sending an email to: cemogo@gmail.com
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:*
PHOTO RELEASE

I consent to the use and disclosure of all images of me by the Monica Costa, Monica Costa Coaching., it's agents or representatives, other participants or a contracted advertising agency, in whole or in part, in all forms and media, for distribution to the general public for the purposes of publicity and promotion in various media (e.g. printed materials, website, social media). I further consent to the reproduction or use of the photographs or video footage and consent that Monica Costa, Monica Costa Coaching, may seek copyright of the photographs or video footage in its name. If I am completing this waiver as the authorized parent/guardian of a minor, I understand that I am answering this question on the child's behalf.


I consent
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 Information
Please choose THE ACTIVITIES you will be participating in*
Please Select
Breathwork
Movement - Yoga, Ski, SUP, SUP Yoga
Mindset / Personal Coaching
All Activities
BREATHWORK - have you participated in guided breathwork before?*
YOGA - How would you rate your yoga practice?*
SKI - How would you rate your ability to ski?*
SUP / SUP Yoga - How would you rate your ability to swim?*
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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