Liability Waiver Please call 403-208-3307 if you have any questions. Instructions Please fill in the form below to register for your 1st class. You will receive a confirmation e-mail. Your contact information will only be used to communicate with you about our classes or other events. I do not give your contact information to third-parties. VITAL 1- Exclusively Essentrics® Workouts Liability WaiverImportant: VITAL 1 is not liable for any injury or damages related to the class, given by this instructor. Note: If at any time during the class, you feel discomfort or strain, gently come out of your position. You may rest at any time during the class. It is important that you listen to your body, and respect its limits on any given day. First Name * Last Name * Contact me by: *EmailHome PhoneCell PhoneText Message Email * Phone * Professional Disclaimer Waiver I declare that I do not have an underlying physical condition that would make participation in a fitness class unsafe. I, the undersigned, understand that VITAL 1 is not a substitute for medical attention, examination, diagnosis or treatment. I know the importance of consulting a physician prior to beginning any physically active program, including those offered by VITAL 1. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every VITAL 1 class. I accept that neither the instructor, nor the hosting facility is liable for any injury or damages; to person or property, resulting from taking this class. I agree not to bring a claim against VITAL 1 regarding this class. Those under 18 years of age must have this form signed by a parent or guardian. Emergency Contact Name Emergency Contact Phone Any In-person Classes Being Taken? *YesNo Media Consent I hereby authorize any images or video footage taken of myself, in whole or in part, individually or in conjunction with other images and video footage, to be displayed on the VITAL 1 Website and other official channels, and to be used for media purposes including promotional presentations and marketing campaigns. I waive rights to privacy and compensation, which I may have in connection with such use of my name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith. Media Consent Waiver *YesNo COVID-19 Vaccination Status I hereby delcare that I am fully vaccinated against COVID-19 and it has been 14 days since my last vaccine. COVID-19 Vaccination Completed *YesNo Date Signed I agree to the terms, as indicated above, by providing my name and contact information: *YesNo Select The Date and Time of The Class You Plan To AttendClass Times Drop Down List *▼ Make Your Selection Here ▼Online ClassesMonday @ 10:30 am - Dalhousie (In-person) How did you hear about me? *Community newsletterWord of mouthInternet search (Google, Bing, Yahoo, etc.)Poster boardEssentrics™ WebsiteMail Other - Please specify In-person classes held at the "Dalhousie Community Centre" Haysboro classes held at "Dance With France" NOTE: Please Bring To The Class Section
Liability Waiver Please call 403-208-3307 if you have any questions. Instructions Please fill in the form below to register for your 1st class. You will receive a confirmation e-mail. Your contact information will only be used to communicate with you about our classes or other events. I do not give your contact information to third-parties. VITAL 1- Exclusively Essentrics® Workouts Liability WaiverImportant: VITAL 1 is not liable for any injury or damages related to the class, given by this instructor. Note: If at any time during the class, you feel discomfort or strain, gently come out of your position. You may rest at any time during the class. It is important that you listen to your body, and respect its limits on any given day. First Name * Last Name * Contact me by: *EmailHome PhoneCell PhoneText Message Email * Phone * Professional Disclaimer Waiver I declare that I do not have an underlying physical condition that would make participation in a fitness class unsafe. I, the undersigned, understand that VITAL 1 is not a substitute for medical attention, examination, diagnosis or treatment. I know the importance of consulting a physician prior to beginning any physically active program, including those offered by VITAL 1. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every VITAL 1 class. I accept that neither the instructor, nor the hosting facility is liable for any injury or damages; to person or property, resulting from taking this class. I agree not to bring a claim against VITAL 1 regarding this class. Those under 18 years of age must have this form signed by a parent or guardian. Emergency Contact Name Emergency Contact Phone Any In-person Classes Being Taken? *YesNo Media Consent I hereby authorize any images or video footage taken of myself, in whole or in part, individually or in conjunction with other images and video footage, to be displayed on the VITAL 1 Website and other official channels, and to be used for media purposes including promotional presentations and marketing campaigns. I waive rights to privacy and compensation, which I may have in connection with such use of my name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith. Media Consent Waiver *YesNo COVID-19 Vaccination Status I hereby delcare that I am fully vaccinated against COVID-19 and it has been 14 days since my last vaccine. COVID-19 Vaccination Completed *YesNo Date Signed I agree to the terms, as indicated above, by providing my name and contact information: *YesNo Select The Date and Time of The Class You Plan To AttendClass Times Drop Down List *▼ Make Your Selection Here ▼Online ClassesMonday @ 10:30 am - Dalhousie (In-person) How did you hear about me? *Community newsletterWord of mouthInternet search (Google, Bing, Yahoo, etc.)Poster boardEssentrics™ WebsiteMail Other - Please specify In-person classes held at the "Dalhousie Community Centre" Haysboro classes held at "Dance With France" NOTE: Please Bring To The Class Section
