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Studio b Health & Participation Waiver

Please provide the participant's information below. If you are a guardian filling this out for a minor, please enter the minor's details.


Emergency Contact Information

Spouse / Significant Other

The following is required to be completed prior to participation in any of Studio b’s classes, activities, or programs.

  1. I am participating in an activity or program, and I hereby affirm that I am in sound physical condition and able to participate in this physical activity. I recognize that participation in these exercises is voluntary on my part, and I recognize that physical exertion is required that may be strenuous and may cause physical injury. I am fully aware of the risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the program. In the event of an emergency, I authorize Studio b Dance and Fitness, Inc. (Studio b) and/or the instructor(s) to secure emergency medical treatment(s).

  2. I understand that it is my responsibility to have consulted with a physician prior to and regarding my participation at Studio b. I represent that I have consulted with a physician and warrant that I am physically fit, and I have no medical condition that would prevent my full participation in fitness classes.

  3. I waive any claim I may have against Studio b Dance and Fitness, Inc. and the authorized instructors for damages, and injury, including death, which I may sustain as a result of participating in the activity. I knowingly, voluntarily, and expressly waive, release, and discharge all of the instructors, facility providers, volunteers, sponsors and beneficiaries of this event, their officers, directors, employees, substitutes, agents and successors, from any obligations, liabilities, claims, demands, costs and expenses, including attorney fees arising out of, or in connection with, any bodily injury, however caused, occurring during or after my participation in exercise programs, workshops and certification programs. I forever release, waive, discharge and covenant not to sue Studio b Dance and Fitness, Inc., and the authorized fitness instructors for any injury or death caused by my voluntary participation.

  4. The terms of this waiver shall be binding to me, me heirs, and my legal representatives.

  5. I have read and agree to abide by all of the Studio b policies which can be found on the Studio b website or in a hard copy by request. I understand that Studio b reserves the right to refuse instruction to anyone not abiding by the Studio b policies.

  6. I understand that Studio b is not responsible for lost, stolen, or damaged items.

  7. I understand that Studio b has the right to cancel a class for any reason.

  8. I understand that Studio b’s classes, activities and performances may be photographed and videotaped and used for archival and/or promotional purposes. I allow Studio b to use my name or photographic likeness in all forms of media advertising or any other lawful purpose.

Please provide your consent by selecting one of the boxes below.

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