Agreement of Release and Waiver of Liability Name_________________________________________________________Birthday ____________
Addresss_______________________________________________________ City_______________ State_______________________Zip Code_____________Phone number_____________________ Email____________________________ Referred by______________________________________
I am or will be participating in Kai classes offered thru Kai Moves LLC at Soul Studios 3303 Bahia Vista and at 5000 Fruitville rd. . These classes can be physically demanding based on my own choices in the amount of exertion I do. I recognize that such activity may be difficult and stenousuous and may cause or aggravate a physical injury. I am fully aware of and accept the risks and hazzards involved with this or any physically strenuous workout. I also acknowledge that it is strictly prohibited for any person to participate in the classes offered by Kai Moves LLC that has experienced any serious health conditions or that has been told by a doctor not to exercise for any reason.
I understand that it is my responsibility to consult with a physician prior to and regarding my participating in the Kai classes offered by Kai Moves LLC and to receive approval to participate. I represent and warrant that I am physcially fit and have no medical condition or injury, which would preven my full pariticipation in Kai classes. Initial______
In consideration of being permitted to participate in the Kai classes , I agree to assume full repsonisibilty for any risks, conditions, injuries or damages , known or unkown, which I might incur or aggravate as a result of my participating in same, whether caused by the negligence, gross negligence or otherwise of those released from liablity. Initial________
4. In further consideration of being permitted in the Kai classes, I knowingly, voluntarily and expressly waive any claim Imay have or acquire against Kai Moves LLC, it's owners, employees, independent contractors, instructors or the landlord on the premises, for any injury, condition, or damages that I may sustain as a result of entering or being on the premises or participating in the Kai classes whether caused by negligence, grow negligence or otherwise of those released from liability.
I, on behalf of myself, my heirs, or legal respresentatives that could claim through me forever release, waive, dischage and covenant not to take legal action against Kai Moves LLC, it's owners, employees, independent contractors, instructors, or the landlord on the prmises, for any injury, conditions, or death which arises, is caused by or aggravated by reason of my participation in the Kai classes, whether caused by negligence, gross negligence, or otherwise those released from liability. Initial_______
I understand that it is my continuing responsibility to inform the instructor at Kai Moves LLCc, of any previous medical conditons, injuries, or surgeries prior to my first class and other times as I acquire information as to the same. Initial________
The undersigned has fully read and voluntarily signs this release and further expressly agrees that the foregoing release is intended to ba as broad and inclusive as is permitted by the law of the State of Florida, and in which event if it is concluded that any portion of th erelease is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Initial__________
List any previous conditions, ailments, injuries, and or surgeries____________________ _____________________________________________________________________________
I have read the above Release and Waiver of Liability and fully understand its contents. I vountarily agreee to the terms and conditions stated above.
Signature of the Participant____________________________________________________ Date_______________________________________________
email to be on list: (updates monthly) _____________________