Client Name *

First Name

Last Name

DUE DATE/BABY'S BIRTH DATE *

MM

DD

YYYY

Waiver Release. Please acknowledge the following: *

Acknowledgment of Risk: The Client understand that participating in the exercise program involves a risk of injury, and I am voluntarily participating in these activities with knowledge of the danger involved. I hereby agree to accept any and all risks of injury or death associated with participation in the exercise program.

Health and Safety: The Client confirm that I am participating in the exercise program offered by INNERVERSE STUDIOS, LLC with the consent of my healthcare provider. I affirm that I am either pregnant or have recently given birth, and I have no known medical condition which would prevent my safe participation in the exercise program. I agree to inform INNERVERSE STUDIOS, LLC of any changes in my health and medical condition.

Right to Terminate Participation: The Client understand that at any point, if INNERVERSE STUDIOS, LLC or the instructor does not feel comfortable with my current health to proceed with the exercise program, they have the right to terminate my participation in the current exercise program.

Waiver and Release: In consideration of being permitted to participate in the exercise program, I "Client", for myself, my heirs, personal representatives, or assigns, do hereby release, waive, discharge, and covenant not to sue INNERVERSE STUDIOS, LLC, its officers, employees, and agents from liability from any and all claims resulting in personal injury, accidents, illnesses (including death), and property loss arising from, but not limited to, participation in the exercise program.

Indemnification: The Client agree to indemnify and hold harmless INNERVERSE STUDIOS, LLC from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees brought as a result of my involvement in the exercise program and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State in which the activities are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I have read this release of liability and assumption of risk agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Today's Date *

MM

DD

YYYY

EMERGENCY CONTACT *

First Name

Last Name

Phone *

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