Loading...


 Parent/Guardian Release and Waiver of Liability


I am the parent or legal guardian of the child named above and I give permission for my child to participate in a Pilates reformer class instructed by KOB Pilates LLC, doing business as KOB Pilates and Yoga, and Kinh O'Brien individually (together, "KOB"). I understand that this class involves physical exertion and the use of reformer equipment, which has a moving carriage, springs under tension, straps, ropes, and pinch points. Risks include, but are not limited to, muscle strains, sprains, pinched fingers, falls when getting on or off the equipment, and other physical injury.

I confirm that my child is physically able to participate and that I have disclosed above any injury or condition that could affect participation. I understand it is my responsibility to consult a physician if I have any concern about my child's participation.

I understand that my child must follow the instructor's directions, stay off equipment unless instructed, and tell the instructor immediately about any pain or discomfort. The instructor may modify or stop my child's participation for safety.

On behalf of myself and my child, I voluntarily assume the risks of participation and, to the fullest extent permitted by law, release and waive any claims against KOB Pilates LLC, doing business as KOB Pilates and Yoga, and Kinh O'Brien individually (together, "KOB"), and KOB's owners, instructors, and agents, for injury or damages arising from my child's participation.

Emergency medical treatment: If I cannot be reached, I authorize the instructor to call 911 and to obtain emergency medical care for my child. I am responsible for the cost of such care.Copy and paste the body of your waiver here.


 Event Details

Event: Pilates reformer class for youth baseball players

Date/time: Friday, October 2, 2026

Location: Bend Pilates, Bend, Oregon (rented space)

Instructor: Kinh O'Brien. KOB is renting this space and is a separate business from Bend Pilates.


I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, UNDERSTAND IT, AND SIGN IT VOLUNTARILY ON BEHALF OF MYSELF AND MY CHILD. I AFFIRM THAT I HAVE THE LEGAL AUTHORITY TO SIGN FOR THE CHILD NAMED ABOVE.

Please select who will be participating...
AdultMinor
Continue
First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Parent or Guardian's Date of Birth*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!