Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

By signing up for and/or attending Embody by Cam classes, private sessions, activities and other programs (individually and/or collectively, the “Classes”) and using the premises, facilities and equipment or any other location or venue where Embody by Cam is providing services (individually and/or collectively, the “Facilities”) of Embody by Cam, LLC, its parent and subsidiaries (collectively, “Embody by Cam”):

I hereby acknowledge on behalf of myself, my heirs, personal representatives and/or assigns, that there are certain inherent risks and dangers in participating in Embody by Cam classes, yoga, pilates and the use of exercise equipment in association with the Classes and Facilities. *

I agree

I acknowledge that I have read and thoroughly understand the scope of the Classes, any and all materials regarding the Classes provided by Embody by Cam and/or event planners and have had the opportunity to ask questions regarding the risks associated with the Classes and I acknowledge that some of these risks cannot be eliminated regardless of the care taken to avoid injuries. *

I agree

I also acknowledge that the specific risks vary from one activity to another, but range from (1) minor injuries such as bruises and sprains: (2) major injuries such as joint or back injuries, heart attacks and concussions: and (3) catastrophic injuries including paralysis and death *

I agree

I represent that I (a) have no medical or physical condition that would prevent me from properly participating in the Classes and using the Facilities, (b) do not have a physical or mental condition that would put me in any physical or medical danger and (c) have not been instructed by a physician to not participate in physical exercise. I acknowledge that if I have any chronic disabilities or conditions, I am at risk in participating in Embody by Cam’s Classes, and should not be participating in any Classes or using the Facilities. *

I agree