wAIVER + RELEASE OF LIABILITY FORM

* please complete and submit form prior to class participation

First name

Last name

Age

Phone

Address

Emergency Contact Name

Emergency Contact Number

I the undersigned, being aware of my own health and physical condition and having knowledge that my participation in this program, am voluntarily participating in the Evolve Wellness Studio, which has been explained to me verbally.

Having such knowledge, I hereby release Evolve Wellness Studio & 2265567 Ontario Inc. and its Certified Personal Fitness Trainers from liability for,

a) accidental injury, illness or death

b) loss of damage or theft of personal property

c) occupiers liability

d) Negligence, as a result of participating in the, said fitness program procedures which I may incur.

I hereby assume all risks connect therewith and consent to participate in said program.

I agree to notify my Personal Fitness Trainer at Evolve Wellness Studio if any changes occur or if any information on this form needs updating.

As well, I agree to notify my Personal Fitness Trainer at Evolve Wellness Studio if I am unable to attend my fitness session 24 Hours before the scheduled session, as stated in Evolve Wellness Studio's policies.

Dated at the city of Belleville, Province of Ontario

Date

Name Printed

Participant's Signature

Witness

Personal Fitness Trainer

Please share any obstacles that challenge you from moving toward optimal health!

Please share any wellness goals you have

Who referred you to Evolve?