PNW Seminars & Posing Class Registration
Please complete entire registration form. Select the classes/seminars that apply and pay fee according.
FIRST NAME *
Your answer
LAST NAME *
Your answer
MOBILE *
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EMAIL *
Your answer
CITY/STATE *
Your answer
NEW TO BODYBUILDING? *
ARE YOU WORKING WITH A COACH? *
If "Yes", type name or team name. If "No", then indicate if you are "seeking coaching".
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WHICH DIVISION(S) ARE YOU TRAINING FOR? *
WHICH SHOW(S) ARE YOU REGISTERED FOR? *
If you are registered, provide date, location, and name of show. Type in "need guidance" for help in decision.
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HOW DID YOU HEAR ABOUT PHYSIQUE NORTHWEST EVENT? *
Examples: Facebook, Friend, Trainer, Physiques Northwest Member
Your answer
WHICH VENUE ARE YOU ATTENDING CLASS(ES)? *
Seminar + posing classes are offered in the Seattle area, Yakima, Tacoma, and Portland. Follow our Facebook page to receive notifications of upcoming events.
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WHICH DATE(S) ARE YOU ATTENDING CLASS(ES)? *
Seminar + posing classes are offered in the Seattle area, Yakima, Portland, Coeur d’Alene, ID and beyond. Follow our Facebook page to receive notifications of upcoming events.
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CLASS/SEMINAR FEES *
>>> ONLINE PAYMENT LINK FOR POSING INSTRUCTION: http://wp.me/P65hES-22 <<<
FITNESS WAIVER/RELEASE *
FITNESS WAIVER AND RELEASE: Physical exercise and activities can be strenuous and subject to risk of serious injury. I urge you obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise or other activity. You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendation for changes in food, nutrition, and diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely at your discretion and responsibility, and consultation with a health care professional is strongly recommended. I intend to use some or all of the activities, facilities, programs and services, and products offered or recommended by Marlina T. Velasco, Director/Trainer/Instructor. In consideration of being allowed such use, I do hereby waive, release and forever discharge Trainer/Instructor, employees, agents, representatives and all others acting on its behalf from any and all claims or causes of action (known or unknown) for any and all injury, illness, damage or loss that may occur to me or my property as a result of my participation in any aspect of the activities, facilities, programs and services offered at or by the Director/Trainer/Instructor, including, but not limited to, my use of equipment or machinery in connection with the activities, facilities, programs and services offered. I understand that each person (myself included) has a different capacity for participating in such activities, facilities, programs and services. I am aware that all activities, facilities, services and programs offered are either educational, recreational or self-directed in nature. I agree that my participation in any and all of the activities, facilities, programs and services provided at or by the Trainer/Instructor is strictly voluntary. I further agree that my participation in any and all activities, facilities, programs and services provided at or by the Director/Trainer/Instructor is at my own risk and that I assume any and all risk of injury, illness, damage or loss that might result. I also agree to assume all risk of damage, loss or theft to or of any of my personal property. I declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in any of the activities, facilities, programs and services offered at or by the Director/Trainer/Instructor. I acknowledge that I have either had a physical examination and have been given a physician’s permission to participate in these activities, facilities, programs and services, or that I have decided to participate in these activities, facilities, programs and services without the approval of my physician. I do hereby assume all responsibility for my participation in the activities, facilities, programs and services offered at or by the Director/Trainer/Instructor and for my utilization of any and all equipment and machinery in connection with these activities, facilities, programs and services. I understand that the activities, facilities, programs and services offered by the Director/Trainer/Instructor may sometimes be conducted by persons who may not be knowledgeable, licensed, certified or registered instructors or professionals. I accept the fact that the skills and competencies of Director/Trainer/Instructor, some employees, agents, representatives or volunteers will vary according to their training and experience and that no claim is made to offer assessment or treatment of any mental or physical disease or condition by those who are not duly licensed, certified or registered and employed to provide such professional services. I hereby grant permission to Trainer/Instructor, some employees, agents, representatives or volunteers, to take and use: photographs and/or digital images of me for use in news releases and/or educational materials. These materials might include printed or electronic publications, web sites or other electronic communications. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions shall be the property of Trainer/Instructor. By checking box below, you acknowledge that you have carefully read this “Fitness Waiver and Release” and fully understand that it is a release of liability, and cannot be modified orally. You expressly agree to release and discharge the Director/Trainer/Instructor from any and all claims or causes of action and you agree to voluntarily waive any right to bring legal action against Director/Trainer/Instructor. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence. If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the remainder of this release shall remain in full force and effect and the offending provision or provisions severed here from.This e-form will remain on file for the duration of your training, and a copy will be available for your records upon request. Duplication or dissemination of this document to a third party requires your expressed, written consent.
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