Sewickley En Pointe

RELEASE OF LIABILITY for adult and Neuro-Stability CLASS NAME________________________________________________________________ DATE _________ ADDRESS___________________________________________________________________                EMAIL________________________________________________________________ PHONE______________________________________

Please list any health-related conditions that you have or have had that could affect your ability to participate in class - including but not limited to surgeries, joint replacements, fusions, joint pain, autoimmune disorders, cancer, pregnancy, muscle, tendon or bone injury, and any chronic pain.

_________________________________________________________________________________

_________________________________________________________________________________

I ____________________________________ being aware of my own health and physical condition  1) Certify that my participation in the class is a potentially hazardous activity. I have been informed of and understand and aware that any exercise and/or fitness activities involve a risk of injury, and that I am voluntarily participating in these activities with understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury regardless of severity. INITIALS:___________

2) I understand that all information and services provided by Sewickley En Pointe, LLC are of a general nature and are provided for educational purposes only. None of the information or services provided by Sewickley En Pointe, LLC are to be taken as medical or other health advice pertaining to any specific health or medical condition that I have or may have had. The information and services provided by Sewickley En Pointe, LLC are not a diagnosis, treatment plan or recommendation for a particular courseof action regarding my health and are not intended to provide specific medical advice. INTITALS:___________

General Photography Release

I hereby authorize Tonya Ford, of Sewickley En Pointe, LLC to publish photographs and my likeness, for use in Sewickley En Pointe’s print and online marketing materials.  I hereby release and hold harmless Sewickley En Pointe, LLC from any reasonable expectation of privacy or confidentiality associated with the images specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type for these photographs.

SIGNATURE__________________________________DATE__________________________

Sign Up for class updates!

sign up now to get updates from Sewickley En Pointe about classes and workshops.