Name______________________________________

Address___________________________________

City______________________

State____________________

ZIP______________________

Cell phone_________________

Email address______________

Date of Birth____/____/____

Emergency Contact: Name_____________________ Phone_____________________

In the event of an emergency, I authorize BURN - Ventura Lagree (AKA simply “BURN”) to seek medical assistance on my behalf. I agree to be responsible for any costs incurred. YES____ NO_____

Please disclose any physical issues or concerns that Sherri should know about:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Use of my image/likeness for marketing: If applicable, and with my specific permission, I approve of photos from my session(s) or time on the premises being used for online promotion of BURN (consent can be withdrawn at any time with written notice to BURN). YES____ NO____

Training/Stretch Session Guidelines:

• All classes and training sessions are scheduled by online appointment only. Any open spaces may be available to walk-in clients (but not guaranteed) at BURN’s discretion.

• All payments are due before the start of a class/session and are non-refundable

• Minimum age requirement at BURN is 13 years, with parent/guardian permission under 18 years.

• Cancellation of class/session reservations are requested with 12 hour notice. If a session is cancelled with less than 4 hour’s notice, a $20 fee will be charged.

In signing this waiver, I acknowledge that participation in fitness, stretch or other services at BURN involves inherent risks, including but not limited to physical injury, illness, or property damage. I voluntarily assume full responsibility for these risks and agree to release and hold BURN, its staff, agents, and property owners harmless from any claims, liabilities, or damages arising from my participation, including those related to negligence or equipment failure and/or malfunction.

I further agree to indemnify and hold BURN harmless against any expenses or liabilities resulting from my actions during the sessions or while on the Premises. By signing, I confirm I am in good physical health, have disclosed any relevant medical conditions or limitations, have consulted with my medical provider regarding any concerns or limitations I may have regarding the soundness of me engaging in such training and/or services. I understand this waiver is legally binding under California law. If any provision of this agreement is deemed unenforceable, the remaining provisions shall remain in full force and effect.

Signature__________

Date_____________

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