PLEASE SIGN OUR WAIVER OF LIABILITY AND INFORMED CONSENT RELEASE

I hereby certify that I am voluntarily participating in a physical conditioning and corrective exercise program based on the works of Joseph Pilates with Momentum Pilates, Inc. I hereby affirm that I am in good physical condition, have my physician’s approval, and do not suffer from any disability that would prevent or limit my participation in the program. In addition, I certify that I understand the potential risks of the program after having had the opportunity to inquire in detail regarding all aspects of the program, and to have all questions with regard to the program satisfactorily answered, including physiological changes that can occur.

I agree to release from all liability and to indemnify Momentum Pilates, Inc., its officers, directors, shareholders, agents and all representatives from and against claims, actions, judgments, costs, expenses, and demands with respect to injury, loss, death, or damage to my person or property in connection with my taking part in the above stated program. It is understood and agreed that this agreement is to be binding on my heirs, my executors, administrators, assigns, and myself.

CANCELLATION POLICY: I understand that if I may cancel a scheduled appointment, I must notify Momentum Pilates Studio at least 24 hours in advance or I will be held responsible for the session fee. It is also understood that the sessions I sign up for must be completed within 1 year of the purchase date.

In addition, I understand that if I decide to discontinue my practice at Momentum Pilates Studio, whether I notify the studio or not, my sessions fees will not be refunded.

I certify that I have read the above and understood it. Intending to be legally bound hereby, I make this agreement on this day: