Nia Liability Waiver

TUESDAY + THURSDAY 10AM PT CLASSES NOW ON ZOOM.

YAY, YOU’RE SIGNED UP FOR NIA CLASSES!

Please fill out this information so I can get to know you and your needs, check all the boxes, and you’ll be set to go:

I understand that I am participating in the classes and workshops offered by Allison Rivers Samson, a licensed Nia instructor, during which I will receive information and instruction about health and fitness. I recognize that fitness programs require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. With this knowledge I hereby release, waive, indemnify and hold harmless Allison Rivers Samson from any liability for all claims, demands and physical or otherwise injuries or harm suffered by my person or property arising out of or facilities provided by Allison Rivers Samson.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in Allison Rivers Samson’s class. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation.

I understand that Allison Rivers Samson’s instruction is not a replacement for medical care and that any information provided is for educational purposes only and is not meant as a substitute for medical advice.

I understand it is solely my responsibility to keep Allison Rivers Samson updated on any changes in my physical health and I understand that Allison Rivers Samson shall not be liable should I fail to do so.

I have carefully read and understand the foregoing provisions. By checking this box, I hereby certify and acknowledge I understand and agree to be legally bound by the terms and conditions set forth in the specific provisions for which I have checked boxes..

TUESDAY + THURSDAY 10AM PT CLASSES NOW ON ZOOM.

YAY, YOU’RE SIGNED UP FOR NIA CLASSES!

GET YOUR FREE SESSION!