NJAPE Inclusive Movement Center
Not all fields may apply, please just check off the ones that are needed.
What is the participant name(s)? *
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Age of the participant(s) *
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Parents'/guardians' names (if participant is a child) *
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Home address and Email *
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Emergency contact information (name, relationship to participant, phone number) *
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Does the participant(s) have any medical health issues that we need to aware (i.e. seizures, cardio impairments, etc?). If yes, please clarify. *
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Is the participant allergic to any material (i.e. Latex)? If yes, please clarify. *
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Please select the class that you would like to register for.
Please indicate if you would like to register for more than one class.
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Please indicate if you would like to register more than one child.
Your answer
Please select the Training Session slot you would like to register for
If applicable, can you indicate if your child has any special need we need to discuss prior to their involvement. *
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Does NJAPE have permission to photograph / video your family members during sessions for marketing purposes? *
I understand that there are health risks associated with activities in this exercise class. These health risks include, but are not limited to transient dizziness, fainting, nausea, muscle cramping, musculoskeletal injury, sprains and strains, heart attack, stroke, or sudden death. If I experience any of these or any other symptoms while exercising, I will discontinue the activity, notify the instructor, and consult my physician. I am capable of performing physical exercise and acknowledge that I am voluntarily participating in this exe cerise program. I am participating in the exercise program with the knowledge of dangers and risks involved. I understand that I am fully responsible for complying with any restrictions prescribed for me by my personal physician and that I agree to consult my personal physician for further evaluation and such medical care as I require. I am responsible for my own health and actions in this exercise program. I am voluntarily participating in the fitness activities and aware of the risks involved. In consideration of the acceptance of my application as a voluntary participate to NJAPE Inclusive Movement Center. I hereby agree to assume all risks attendant upon myself while participating in this center. I hereby waive, release and discharge any and all claims for health, personal injury, or property damage which I may have, or which may hereafter accuse to me, as a result of participation on the NJAPE Inclusive Movement Center. I agree to indemnify and hold harmless from liability the NJAPE Inclusive movement Center and it's members and/or any of their agents, servants, volunteers, or employees by reason of any accident, death, injury, or damages, injury, or damages to persons or property which I may suffer, from and against any and all liability arising out of or connected in any way with my participation organized by NJAPE Inclusive Movement Center even though that liability may arise out of negligence or carelessness on the part of persons or entities mentioned above. It is further understood and agreed that this waiver, release, and assumption of risk to be binding on my heirs and assigns of me. I agree to assume all responsibilities for any damage or injury to any person caused by me while participating in the NJAPE Inclusive Movement Center. I have read, and understand the release of liability form. I also am signing off on the release of liability form as the parent or guardian for my child who is under 18 years old. NJAPE adopts best practices when attempting to resolve any behavioral issue. Our goal is to help all participants learn how to work and play cooperatively. If in the event a participant is exhibiting self-injurious, aggressive to others behavior, or is consistently not adhering to our instruction then we reserve the right to dismiss that individual from a class or program without a refund of payment. We want all participants to achieve, be challenged, and feel comfortable, therefore we will do our very best to ensure that class selection is the best possible match. *
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