Name *

First Name

Last Name

Waiver *

Please check the box to certify to be in proper physical condition to participate in training with Erika Vipond. I will inform the trainer, Erika Vipond, of any specific physical conditions that I may have. I agree that Erika Vipond, her officers, employees and agents shall not be liable for any claim, demand or cause of action of any kind resulting from or related to the use of the facilities or participation in any sport, exercise or activity within the club/studio premises. I accept that neither the instructor nor the host facilities are liable for theft and or loss of personal effects or damages to property, resulting from taking this class. Finally, I release Erika Vipond and the host facility from all liability for injuries or physical problems.