New Client Intake Form & Waiver of Liability If this is your first time at the studio, please submit this form prior to class.P.S. You’ll need to complete the form in one sitting, as it’s not able to save your information. QUESTIONS?We’re happy to help.Contact Us Here YOUR CONTACT INFORMATION: Your Name: * First Name Last Name Your Mailing Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Your Email Address: * Your Phone Number: * (###) ### #### Name of Emergency Contact: * First Name Last Name Phone for Emergency Contact: * (###) ### #### OUR CONNECTIONS: How did you hear about INjoy Studio? Would you like to receive email announcements about future classes & workshops? Yes, please add me to the studio mailing list. YOUR HEALTH INFORMATION: In what ways would you like to improve how you move through your daily life? Briefly describe your current exercise, hobbies, and physical activities. Include your occupation and activities related to it. Please list any current medical conditions and medications. Please describe any injuries and/or surgeries, including any minor accidents/trauma resulting in pain, numbness, or decreased use of your body. Please describe any areas of physical discomfort, stress, or tension. What alleviates/aggravates those sensations? Is there anything else you'd like to share? AGREEMENT OF RELEASE & WAIVER OF LIABILITY * I recognize that classes at INjoy Movement LLC will require physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in classes with Yarrow Denise King and at INjoy Movement LLC. I represent and warrant that I am physically fit and have no medical conditions that would prevent my full participation in the class, health program, or workshop. I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, that I may incur as a result of participating in the class. I knowingly, voluntarily, and expressly waive any claim that I may have against the instructor for injuries or damages that I may sustain as a result of my participation. My heirs, my legal representatives, and I forever release and waive any liabilities against Yarrow Denise King, INjoy Movement LLC, and any instructors at INjoy Movement LLC, for any injury incurred by my voluntary participation in the class, workshop, or activity. I HAVE READ AND FULLY UNDERSTAND THE ABOVE RELEASE AND WAIVER OF LIABILITY. I VOLUNTARILY AGREE TO THE TERMS AND CONDITIONS STATED ABOVE. * First Name Last Name Date MM DD YYYY Thank you! Your New Client Intake Form + Waiver Agreement has been successfully submitted. See you in class!
