Form Description:

Please read this waiver carefully before signing. By submitting this form electronically, you acknowledge that you have read, understood, and agree to all terms below.

Section One: Participant Information

First name

Last name

Phone

Emergency Contact Name and Phone Number:

Date

Month

Day

Year

SECTION 2:

WAIVER AND RELEASE OF LIABILITY

This document confirms my awareness that I will be engaging in physical exercise involving various sports, coordination events, dance fitness, and general fitness training at Reflexion Fitness and Wellness.

I understand that participation in these activities may cause injury, illness, or death.

By signing this waiver, I acknowledge that I am voluntarily participating in these activities and assume all risks associated with participation, including but not limited to:

Slipping, tripping, or falling
Muscle strains or tears
Equipment-related injuries
Dizziness or fainting
Serious injury, illness, or death

I understand that participation in exercise and fitness activities carries inherent risks of physical injury and potential loss or damage to personal property.

I agree to assume all risks of injury, loss, or damage to property.

I further agree to indemnify and hold harmless Reflexion Fitness and Wellness, LLC, Laura Lanni, partners, employees, contractors, personnel, and agents from any liability, loss, cost, damage, expense, claim, or suit resulting from or related to my participation, regardless of negligence.

I grant permission for first aid and/or CPR/AED to be administered to me in the event of an emergency.

I understand that I am solely responsible for any medical costs or expenses that may arise from participation or emergency treatment.

I understand that no evaluation of my physical fitness or readiness for participation will be performed by Reflexion Fitness and Wellness.

If I have any physical or mental condition that may impair my ability to safely participate, it is my responsibility to obtain physician clearance before participation.

It is strongly recommended that anyone participating in physical exercise consult with a physician beforehand.

Liability Agreement

Checkbox – Required

I have read and fully understand the Waiver and Release of Liability and voluntarily agree to all terms.

SECTION 3: PHOTO / VIDEO RELEASE

I hereby consent to the use of my photograph and/or recorded image that may appear in publications, promotional posters, flyers, brochures, printed materials, electronic advertisements, social media, websites, or other electronic media related to Reflexion Fitness and Wellness.

Photo/Video Consent

Yes, I consent to photo/video use

No, I DO NOT consent

Medical Conditions/Health Screening

Do you have any medical conditions, injuries, or limitations we should be aware of?

Are you currently under a physician’s care for any condition affecting exercise participation?

YES

I certify that I am physically able to participate or have received medical clearance.

Cancellation/Refund Policy

I understand all memberships, class packages, events, and services are subject to Reflexion Fitness and Wellness policies regarding cancellations, no-shows, and refunds.

I acknowledge Reflexion policies.

SECTION 4: ELECTRONIC SIGNATURE

Type FULL LEGAL NAME:

Date

Month

Day

Year

Signature

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FINAL AGREEMENT

By checking this box and submitting this form, I acknowledge that my electronic signature is legally binding and equivalent to a handwritten signature.

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