AERIAL MOON – STUDENT CONTRACT
First Name: ______Last Name:______
Date of Birth: ______/______/______
Mailing Address:______
E-Mail Address:______
Best Telephone Number to Reach You:(______)______
Emergency Contact:______Telephone:(______)______
Responsibility Waiver:
I understand that it is my responsibility to consult a physician regarding my participation in all programs offered prior to attending.
I understand that it is my responsibility to inform the Yoga/Aerial Instructor of any injuries and/or limitations that might affect my practice before each class I attend.
I understand that I am participating in programs that may involve hands-on adjustments to my body. I am permitting all instructors and their assistants to touch and adjust my body in accordance with professional standards.
I acknowledge and understand that participation in yoga and aerial yoga classes entail known and unanticipated risks that could result in physical or emotional injury, paralysis, death or damage jeopardizing the essential qualities of the activities. Without a certain degree of risk, students would not improve their skills and the enjoyment of activities would be diminished. I expressly agree and promise to accept and assume all of the risks existing in this activity, my participation is purely voluntary, and I elect to participate in spite of risks.
In accordance of being permitted to participate in the programs with Aerial Moon and Jaine Marquis, I assume full responsibility for any risks, injuries, or damages, known or unknown, which might incur as a result of my participation in the program. I release and agree to indemnify and hold harmless Aerial Moon and Jaine Marquis & the hosting facility location and their representatives, officers, agents and directors from any and all losses and claims, even if arising from their negligence, to the fullest extent permitted by law. It is expressly agreed that all use of the facilities and premises (including but not limited to stairs, parking areas, walkways) shall be undertaken at my own risk.
**POLICY OF MISSING A REGISTERED SESSION OR WORKSHOP**
If I am going to miss a session or workshop which I have pre-registered for, it is my responsibility to let the instructor know 24 hours in advance or I will be charged 100% for the scheduled session/workshop (exceptions are only made in the case of emergencies).
Full cancellations MUST be made a full 24 hours in advance, exceptions are only made in the case of emergencies, Less than 24 hours’ notice and I understand that I will be liable for payment of 100% of the scheduled session/workshop fee.
SIGNATURE:______Date:______/______/______
**For Parents/Guardians/Participants of Minor Age (under 18 years old)**
By my Signature below, I certify that I, as LEGAL PARENT/GUARDIAN with legal responsibility for this Participant do consent and agree to his/her release to this program. I also agree to all Terms & Conditions stated above in the Responsibility Waiver in regards to both my child and myself.
PARENT/GUARDIAN’s FULL NAME (print):______
PARENT/GUARDIAN’s SIGNTURE:______Date:____/____/_____