Registration private session

Name

DOB

Emergency Contact Name & Number:

Phone number

Address

Have you had any form of illness/disease e.g. asthma, diabetes, epilepsy?

What are your intentions or hopes for these sessions?

Is there a main physical or emotional issue you would like to focus on?

Do you have any diagnosed medical conditions?

Have you had any surgeries, accidents, or major injuries?

Are you currently receiving other therapies or treatments?

Are you currently taking any medications or supplements?

What types of movement or exercise do you currently do?

Is there anything else you'd like to share before your first session?

If you answered yes to any of the questions listed above, please consult your doctor on this before starting the movement classes. Liability Waiver:

In being allowed to participate in any training provided by Gita Fitness and to use the facilities managed/owned by Gita Fitness and/or under the control of Gita Fitness, in addition to the payment of any fee of charge, I do hereby waive release and forever discharge Gita Fitness from any and all responsibilities or liability for injuries resulting from my participation in activities or use of the above equipment during a training session. I recognize that the program may involve strenuous physical activity, including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training and other various fitness activities. I also understand that exercise and fitness activities involve a risk of injury and even death, and I am voluntarily participating in these activities and using the equipment and facilities in the knowledge of any dangers involved. I hereby expressly assume and accept all and any risks of injury or death. I am aware that I have the right to request advice from the course instructor in relation to the activities and exercise being undertaken with particular regard to my health. If I choose to take advice or disregard any advice given, I do so voluntarily and accept liability for all resulting injuries and damage. I hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment or facilities except as herein stated. I acknowledge that my enrolment and subsequent participation is done so on the basis that I have had a physical examination and have been given doctor’s clearance to participate and that I have voluntarily decided to participate in activity and utilization nor equipment and machinery in my activities. In addition, Gita Fitness cannot accept any responsibility for items lost during training sessions. By signing this waiver, I also grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other for any legitimate promotional purposes.

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