WILD Movement: New Student Info and Waiver

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Registration and waiver for all WILD Movement classes

NEW STUDENT INFO

Today’s full date *

Full name *

Full address *

Email Address *

Phone number (you will only be called or texted in the event of a sudden cancellation of a class for which you've registered). *

Previous experience with movement (yoga, pilates, etc) *

Beginner

Intermediate

Advanced

Do you have any medical restrictions, injuries, or conditions that we should be aware of to help you have the best experience? *

Yes

If yes, please explain

Is there anything specific you're looking to gain from our movement classes? *

Would you like to receive emails about futures classes and retreats? *

Yes

WAIVER AND DISCLAIMER

All questions must be answered "Yes" in order to participate in a WILD Yoga class.

I hereby consent as a participant in WILD Movement classes and agree to assume all of the risks involved. I release WILD Way Wellness, Nick Osborne, and Jamie Osborne from any known or unknown injury, accident, or hazard, previously, during, or after participation in a WILD Movement class and/or training or related activities; and that I cannot hold WILD, affiliated teachers, or location host, personally responsible for any liability. *

Yes

If attending in-studio classes: As per current provincial health restrictions (for in person classes), I hereby declare that I am not currently feeling any Covid symptoms such as cough, fever, difficulty breathing, sore throat, etc. I declare that I will not attend any classes if any of these change. *

Yes

I am doing classes online only

I recognize that any form of physical activity has potential risk of injury. I hereby affirm that I am voluntarily participating in a WILD Movement activity with the knowledge of the risk involved. I assume and accept any and all risks of injury and hazards. *

Yes

I hereby affirm myself to be in physical condition to practice in WILD Movement with no medical condition or injury preventing me from participating. I declare that I have disclosed any and all medical issues to WILD and/or their affiliates relevant to participation or have been cleared by a physician to participate in class and/or training. *

Yes

Please type your initials to indicate that all information you have provided is accurate. This represents your electronic signature. *

Any final questions or comments, or anything to clarify any of the above?

Submit

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