Please read this waiver carefully.
You do not need to print or sign this version. A paper copy will be provided for you to sign before your first lesson.
PRIVATE LESSON INTAKE FORM AND AGREEMENT
This Private Lesson Intake Form and Agreement (the “Agreement”) is entered into as of by and between Antonia Cartwright of Antonia Cartwright LLC (“Teacher”) and __________________________________, a (“Student”).
Teacher and Student agree as follows:
Section 1. General Policies
All private lessons must be scheduled at least 24 hours in advance and they will take place at a location mutually agreed upon by the Teacher and the Student. All private lessons are 60 minutes in length unless otherwise agreed by both the Teacher and the Student in advance.
Section 2. Cancellations and Lateness
The Student will provide at least 24 hours notice if needing to reschedule an appointment (except in event of an emergency). There will be no refunds of the fees paid for unused private lessons, but the lessons may be transferred to someone else. The pricing for private lessons is mutually agreed between the Teacher and the Student. The Student understands that if he or she is late for an appointment, the Student’s class will still end at the scheduled time.
Section 3. Privacy
The Student’s personal and medical information will not be shared with anyone except in an emergency or if the Student specifically directs the Teacher to do so in writing.
Section 4. Release
4.1 The Student is participating in yoga classes, health programs and other exercise and healing arts activities (collectively, the “Activities”) offered by the Teacher. The Activities may include the use of equipment, props, and physical (i.e., hands-on) assists from the Teacher. The Student will advise the Teacher if they do not want to receive physical assistance.
4.2 The Student recognizes that the Student must be in good physical and mental health to participate in the Activities. The Student understands that the Activities require physical exertion and the Student represents and warrants the Student is physically fit and has no medical condition which would prevent full participation in the Activities. The Student understands that it is the Student’s responsibility to consult with a physician prior to, and regarding participation in the Activities. If the Student has consulted a physician, the Student has taken the physician’s advice.
4.3 The Student is in proper physical condition to participate in the Activities, and is aware that the participation could, in some circumstances, result in abnormal blood pressure, fainting, heartbeat disorders, physical injury and potentially heart attack. The Student also understands that the Student could experience muscle, back, or bone injuries during exercise. The Student understands his or her physical limitations and is sufficiently self-aware to stop physical activity before the Student becomes ill or injured. The student understands that it is The Student’s continuing responsibility to inform the Teacher of any previous medical conditions, injuries or surgeries prior to the first class and any future changes to the Student’s medical condition.
4.4 In consideration of being permitted to participate in the Activities, the Student agrees assume full responsibility for any risks, injuries or damages, known or unknown, which Student might incur as a result of participating the the Activities.
4.5 In further consideration of being permitted to participate in the Activities, the Student knowingly, voluntarily and expressly waives any “Claims” (as defined below) that the Student may have against the Teacher or the Teacher’s assistants (a “Released Party”) for any injury or damages the Student may sustain as a result of participating in the Activities, even if the Claims arise from the carelessness, negligence or gross negligence of any Released Party or anyone else. The Student agrees to indemnify and hold harmless each Released Party from any loss or liability incurred in defending any Claim made by the Student or anyone making a claim on the Student’s behalf, even if the Claim is alleged to or did result from the carelessness, negligence or gross negligence of any Released Party or anyone else.
“Claims” include but are not limited to any and all liabilities, claims, demands, expenses, fees, legal actions, rights of action for damages, personal injury, mental suffering and distress, or death that the Student may suffer, or that the Student’s children may suffer, or that the Student’s unborn child may suffer (including any legal fees or expenses) in connection with participation in any Activity.
4.6 The Student consents to use of any videos or photographs for promotional material or other business purposes. If the student does not consent to such use, the Student will write “No photos/videos” next to their signature below. If the Student provides social media information (e.g., Facebook; Instagram), they consent to communication with these platforms (e.g., messages, photo-tagging).
4.7 The Student’s heirs or legal representatives forever release, waive, discharge and covenant not to sue any Released Party for any Claim caused by any negligence or other acts of a Released Party. This agreement shall be construed in accordance with, and governed by, the laws of the State of California and any other region in which private lessons are conducted.
4.8 The Student acknowledges that the Student has carefully read this release and wavier of liability and fully understands its contents. The Student voluntarily and knowingly agrees to the terms and conditions stated herin. The Student is aware that by signing this release and waiver of liability, the Student is giving up substantial rights, including the right to sue and certain legal rights that the Student’s heirs, next of kin, executors, administrators and assigns may have against any Released Party.
The parties have signed this Agreement as of the last date set forth below.
Signature of Teacher
Signature of Student
If the participant is under 18:
As a legal guardian of ________________________________,
I consent to the above Waiver of Release and Assumption of Liability
Signature of Parent/Guardian