Liability Waiver

Name *

By filling in your name here, you are acknowledging that there is inherent risk to participating in any dance, fitness or flexibility program and you are legally consenting to the following:

I agree and consent to the following: I am voluntarily participating in an exercise/fitness program conducted by Mindy Stovey via online classes. I recognize that the program requires physical exertion that may be strenuous at times 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 the above mentioned program. I represent and warrant that I have no medical condition that would prevent my participation in the program. I agree to assume full responsibility for any risks, injuries or damage known or unknown which I might incur as a result of participating in the program. Such injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness, including death. I knowingly, voluntarily and expressly waive any claim I may have against Mindy Stovey, Mindful Bellydance LLC or Movement with Mindy for injury or damages that I may sustain as a result of participating in the program. I, my heirs or representatives forever release waive, discharge and covenant not to sue Mindy Stovey, Mindful Bellydance LLC or Movement with Mindy for any injury or death caused by their negligence or other acts. I have read the above waiver and release of liability and fully understand it contents. I voluntarily agree to the terms and conditions stated above.

Thanks for submitting!