Liability Waiver & Health Questionnaire

In order to save time and trees, we are asking you to please read, sign and submit this one time electronic waiver and health questionnaire for you and your child/children (if applicable) before the event. These forms will be kept on file and you will not need to fill them out again for future events with us. We look forward to seeing you!

ADULT MEMBER /GUARDIAN DETAILS

First Name *

Email *

Date of Birth *

Last Name *

Phone Number *

ADDRESS

Address *

Province *

Country *

City *

Postal Code *

Include Minor/Child Members *

Child 1: Full Name *

Child 1: Date of Birth *

Add Minor/Child #2 - Click to remove

Child 2: Full Name *

Child 2: Date of Birth *

Add Minor/Child #3 - Click to remove

Child 3: Full Name *

Child 3: Date of Birth *

Add Minor/Child #4 - Click to remove

Child 4: Full Name *

Child 4: Date of Birth *

Add Minor/Child #5 - Click to remove

Child 5: Full Name *

Child 5: Date of Birth *

Add Minor/Child #6 - Click to remove

Child 6: Full Name *

Child 6: Date of Birth *

Add Minor/Child #7 - Click to remove

Child 7: Full Name *

Child 7: Date of Birth *

Add Minor/Child #8 - Click to remove

Child 8: Full Name *

Child 8: Date of Birth *

Current health concerns or challenges you'd like to share for any child listed above: *

PLEASE READ AND CLICK ANYWHERE YELLOW TO AGREE TO THE WAIVER THEN SCROLL TO THE BOTTOM AND SIGN IT

Acknowledgement of Risk and Release of Liability

For Members over the Age of Majority in the Province or Territory in which the Fitness/Health Club Activities are provided by the Organization.

WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!

Every Member Must Read and Understand this Waiver before Participating in Fitness/Health Club Activities.

The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue and other terms of this agreement are entered into by me, the undersigned Member (the “Member”) with and for the benefit of Natasha Hinsche Chwachka, its directors, officers, employees, contractors, sub-contractors, instructors, staff, volunteers, business operators, share holders, agents and site property owners, renters or lessees (the “Organization”).

1. “Fitness/Health Club Activities” includes but is not limited to contact and non-contact Fitness/Health Club activities, lessons, classes, training, use of facilities, programs and services provided to the Member by the Organization.

2. I am aware that there are inherent and significant dangers, hazards and risks (“Risks”) associated with the participation in Fitness/Health Club Activities. I am aware that the Risks include but are not limited to injury from physical contact with other Members, instructors or equipment, performing a skill incorrectly, or potentially dangerous obstacles, conditions on the floor or vicinity of the Fitness/Health Club Activities. I understand that the Risks are relative to my state of fitness or health (physical, mental and emotional), and to the awareness, care and skill with which the Member conducts him or herself while participating in Fitness/Health Club Activities. I acknowledge that all services provided by the Organization are for the sole purpose of self-improvement. I recognize that all services offered by the Organization are not a replacement for medical, counselling, psychotherapy or psychiatric treatment.

3. I freely accept and fully assume all responsibility for all Risks and possibilities of personal injury, death, property damage or loss resulting from my participation in Fitness/Health Club Activities. I freely assume responsibility for my own safety. I agree that although the Organization has taken steps to reduce the Risks and increase the safety of the Fitness/Health Club Activities, it is not possible for the Organization to make the Fitness/Health Club Activities completely safe. I accept these Risks and agree to the terms of this waiver even if the Organization is found to be negligent or in breach of any duty of care or any obligation to me in my participation in Fitness/Health Club Activities.

4. I acknowledge my obligation to inform the nearest employee of the Organization if I feel any pain, discomfort, fatigue or any other symptoms I may suffer during or immediately after my participation in Fitness/Health Club Activities. I understand that I may stop participating at any time, and have the right to immediately withdraw from any exercise or drill in which the conduct of any party seems beyond the scope of training, makes me uncomfortable or which I believe will be harmful to me.

5. I confirm that I have reached the age of majority in the Province or Territory in which I am participating in Fitness/Health Club Activities.

6. In addition to consideration given to the Organization for my participation in Fitness/Health Club Activities, I and my heirs, next of kin, executors, administrators and assigns (my “Legal Representatives”) agree: a. to waive all claims that I or my Legal Representatives have or may have in the future against the Organization; and b. to release and forever discharge the Organization from all liability for all personal injury, death, property damage or loss resulting from my participation in Fitness/Health Club Activities due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error in judgment of the Organization.

7. I agree to be liable for and to hold harmless and indemnify the Organization from all actions, proceedings, claims, damages, costs demands including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with my participation in Fitness/Health Club Activities.

8. I agree that this waiver and all terms contained within are governed by the laws of the Province or Territory in which I am participating in Fitness/Health Club Activities. I hereby irrevocably submit to the jurisdiction of the courts of that Province or Territory.

9. I confirm that I have had sufficient time to read and understand each term in this waiver in its entirety, and have agreed to the terms freely and voluntarily. I understand that this waiver is binding on myself and my Legal Representatives.

For children under the Age of Majority in the Province or Territory in which the Fitness/Health Club Activities are provided by the Organization.

WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!

Every Parent/Guardian Must Read and Understand this Waiver Prior to the child participating in Fitness/Health Club Activities.

The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue and other terms of this agreement are entered into by me on behalf of the above listed child/children (the “Member”) with and for the benefit of Natasha Hinsche Chwachka and Darcie Johnson, its directors, officers, employees, volunteers, business operators, share holders, agents and site property owners or lessees (the “Organization”).

1. I am the Parent/Guardian of the Member and am executing this waiver on behalf of the Member in my capacity as Parent/Guardian and with the intent that this waiver be binding on myself and the Member for all purposes.

2. “Fitness/Health Club Activities” includes but is not limited to contact and non-contact fitness activities, lessons, classes, training, use of facilities, programs and services provided to the Member by the Organization.

3. I am aware that there are inherent and significant dangers, hazards and risks (“Risks”) associated with the participation in Fitness/Health Club Activities. I understand that the Risks are relative to the Members state of fitness or health (physical, mental and emotional), and to the awareness, care and skill with which the Member conducts him or herself while participating in Fitness/Health Club Activities.

4. I freely accept and fully assume all responsibility for all Risks and possibilities of personal injury, death, property damage or loss resulting from the Member participation in Fitness/Health Club Activities. I agree that although the Organization has taken steps to reduce the Risks and increase the safety of the Fitness/Health Club Activities, it is not possible for the Organization to make the Fitness/Health Club Activities completely safe. I accept these Risks and agree to the terms of this waiver even if the Organization is found to be negligent or in breach of any duty of care or any obligation to the Member in the Member’s participation in Fitness/Health Club Activities.

5. I acknowledge the Member’s obligation to inform the nearest employee of the Organization if the Member feels any pain, discomfort, fatigue or any other symptoms the Member may suffer during or immediately after his or her participation in Fitness/Health Club Activities. I understand that the Member may stop participating at any time, and has the right to immediately withdraw from any exercise or drill in which the conduct of any party seems beyond the scope of training, makes the Member uncomfortable or which the Member believes will be harmful to him or her.

6. In addition to consideration given to the Organization for the Member’s participation in Fitness/Health Club Activities, I and my heirs, next of kin, executors, administrators and assigns, as well as the Member’s heirs, next of kin, executors, administrators and assigns (collectively our “Legal Representatives”) agree:

a. to waive all claims that I, the Member or our Legal Representatives have or may have in the future against the Organization; and

b. to release and forever discharge the Organization from all liability for all personal injury, death, property damage or loss resulting from the Member’s participation in Fitness/Health Club Activities due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error in judgment of the Organization.

7. I agree to be liable for and to hold harmless and indemnify the Organization from all actions, proceedings, claims, damages, costs demands including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with the Member’s participation in Fitness/Health Club Activities.

8. I agree that this waiver and all terms contained within are governed by the laws of the Province or Territory in which the Member is participating in Fitness/Health Club Activities. I hereby irrevocably submit to the jurisdiction of the courts of that Province or Territory.

9. I confirm that I have had sufficient time to read and understand each term in this waiver in its entirety, and have agreed to the terms freely and voluntarily. I understand that this waiver is binding on myself, the Member and our Legal Representatives.

Member Signature - Please Sign Here: *

Thank you for helping us save time and trees by completing the online liability waiver and health questionnaire for Steady Effort Yoga & Wellness experiences. We look forward to seeing you! A copy of this waiver has been sent to the email you provided. Please check your Junk Mail folder if you can't find it in your Inbox.

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