I, _________________________________________ hereby agree to the following: I am participating in physical activity at Nourish Mind + Body, LLC, with Audra Bursae, which may include, but is not limited to Pilates. I recognize that any
physical activity may be strenuous and may cause injury, and I am fully aware of the risks and hazards involved in such activity. I represent and warrant that I am physically fit and I and have no medical condition that would prevent my full participation in these exercises. I understand that it is
my responsibility to consult with a physician prior to and regarding my participation in these classes or treatments. If I have any existing medical condition, I have been cleared by my doctor to participate doing Pilates with Audra Bursae and will explain the details below.
In consideration of being permitted to participate in these exercises, I expressly
assume the risks involved, whether or not such risks were created or exacerbated by the Instructor. I release Audra Bursae and Nourish Mind + Body, LLC, his/her heirs, executors, administrators and assigns, its officers, directors, shareholders,employees, teachers, lecturers, agents, health counselors and staff (collectively, the Releasees) from any and all liability, damages, causes of action, allegations, suits,
sums of money, claims and demands whatsoever, in law, admiralty or equity, which against the Releasees, I ever had, now has or will have in the future against the Releasees, arising from my past or future participation with Pilates, unless arising from the gross negligence of the Releasees.
Myself, my heirs or legal representatives , forever release from liability, waive, discharge and covenant not to Audra Bursae, Nourish Mind + Body, LLC, the owners and its agents for any injury or death caused by any negligent act or omission. I have read the above release form and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.