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Starr Pilates
Liability Waiver
First Name
Last Name
Email
Date of Birth
Are you in good physical health? If not , do you have pemission from your doctor to participate in physical exercise
No
Yes
Please specify anything we should know about your health
Initials
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
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