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Health Declaration

Please fill out the following form in order to participate in our activity.

I, (participant), have registered for the classes with Suzan Pascall. I recognise that this exercise class may involve strenuous physical activity including, but not limited too, muscle strength, endurance, cardiovascular conditioning, and other various fitness activities.  I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or otherwise limit my full participation in this physical class.

In addition, I am fully aware of the risks and hazards connected with any exercise or fitness activity involves a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death.  I am accepting such risks and volunteering to participate with full understanding of the dangers involved. 

I herby elect to voluntarily participate in this class knowing that the associated physical activity may be hazardous to me and/or my property. 


I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this CLASS.

I hereby release, waive, discharge, and covenant not to sue Suzan Pascall today’s host and/or any of its, servants, agents, consultants, volunteers, and/or employees from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury (including, but not limited to, death) that may be sustained by me, or to any property belonging to me, while participating in this class, or while on or upon the premises where the event is being conducted including, but not limited to, any claims arising under negligence.

It is my expressed intent that this waiver and release shall bind any and all members of my family including, but not limited to, my spouse, if I am alive, and my heirs, assigns, and personal representatives, if I am deceased.  It is also my expressed intent that this waiver and release shall also be deemed a full release, waiver, discharge, and covenant not to sue insofar as my aforementioned family members, heirs, assigns, and personal representatives are concerned.  

In signing this waiver and release, I acknowledge and represent that I have read and understand the foregoing and hereby sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I hereby execute this waiver and release for valuable consideration, intending to be bound by the same.

Thanks for submitting!

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