Pilates Haven
285 Nicoll Street
New Haven, CT
hello@pilateshvn.com

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Contact Information
All information is kept strictly confidential and is used to assist us better understand your individual needs. Thank you for printing clearly.
Name: *
Address:
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Phone: *
Emergency Contact: *
What are you looking to achieve with Pilates? *
Your Date of Birth: *
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Do you have any injuries or physical conditions which limit your ability to exercise? *
If so, what are they?
It is advisable to check with your doctor before starting any new form of exercise, including the Pilates Method. Should you be recommencing exercise after a period of inactivity, your doctor's advice is strongly recommended.
COVID-19 WAIVER
WAIVER, RELEASE, INDEMNIFICATION & COVENANT NOT TO SUE. In consideration of my participation in PILATES HAVEN LLC, I, the undersigned participant, knowingly and voluntarily agrees to release and on behalf of myself, any participating children, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE PILATES HAVEN LLC, its officers, directors, employees, volunteers, agents, representatives and insurers ("Releasees") from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against PILATES HAVEN LLC on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of PILATES HAVEN LLC facilities/equipment or participation in PILATES HAVEN LLC programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating children due to negligence, active or passive, or otherwise while in, about or upon the premises of PILATES HAVEN LLC and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with PILATES HAVEN LLC. The undersigned acknowledges that any illness or injuries that the undersigned or such participating children contract or sustain may be compounded by negligent first aid or emergency response of the Releasees and waive any claim in respect thereof. In consideration of my participation in PILATES HAVEN LLC programing or access to facilities, I, the undersigned participant, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my program participation or access to facilities. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in fitness program participation and facility use and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in PILATES HAVEN LLC  programing or facility use and that by signing this agreement I HEREBY RELEASE Releasees from all liability for such loss, damage, or death. I further certify that I am in good health and that I have no conditions or impairments which would preclude my safe participation in PILATES HAVEN LLC programming or facility use. I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM PILATES HAVEN LLC IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AT ANY Core Trainers LLC dba mActivity fitness Center FACILITY OR PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO PILATES HAVEN LLC.

By my signature I indicate that I have read and understand this COVID-19 Waiver of Liability. I am aware that this is a waiver and a release of liability and I voluntarily agree to its terms.

I am at least 18 years of age or my parent or guardian is signing this waver form on my behalf.
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LIABILITY WAIVER
I hereby understand and acknowledge that the training provided by Pilates Haven may expose me to many inherent risks, including accidents, injury, or even death. I HEREBY ASSUME ALL RISKS OF PARTICIPATION IN TRAINING AT PILATES HAVEN.

I understand that the process of doing Pilates may involve dialog, questions regarding my health status and history of previous injuries, and that my clear and complete responses are required to ensure the quality and safety of the exercises.

I understand that Pilates involves unique exercise apparatus that I may not be familiar with; that the apparatus is constructed of moving parts, carriage, pedal, foot bar, springs and straps that move with my body; and that the movement of my body and the apparatus could result in the possibility of my falling or being trapped by the movie parts. I understand that my clear and focused involvement is necessary for my physical safety.

The instructor may guide me or ask me to move my body in ways that are new to me, and it is possible that during these movements, pain or injury may occur or be exacerbated. I understand that it is my responsibility to communicate clearly and promptly with my instructor, telling the instructor of any pain, discomfort or physical limitations.

I RECOGNIZE AND UNDERSTAND THAT IT IS MY SOLE RESPONSIBILITY, WITH OR WITHOUT OUTSIDE MEDICAL EVALUATION, TO DETERMINE MY FITNESS FOR PARTICIPATION IN PILATES.

I recognize and understand that there are risks of physical injury inherent in participation in any physical exercise program and that those risks are increased with the use of exercise apparatus and the unique apparatus used in Pilates instruction.

I also understand that the exercise apparatus, particularly the moving parts, may be subject to fatigue or other wear and tear that may not be immediately apparent to me, the instructor or Pilates Haven. I knowingly assume the risks involved in taking Pilates instruction, using Pilates apparatus and exercising at this location.

AFTER HAVING READ THIS WAVER AND KNOWING THESE FACTS, AND IN CONSIDERATION OF ACCEPTANCE OF MY PARTICIPATION AND PILATES HAVEN PROVIDING ME WITH PILATES INSTRUCTION, I AGREE, FOR MYSELF AND ANYONE ENTITLED TO ACT ON MY BEHALF, TO WAIVE ANY RIGHT TO SUE PILATES HAVEN, ITS INSTRUCTORS, EMPLOYEES, AND AGENTS AND RELEASE THEM AND HOLD THEM HARMLESS FROM ANY FUTURE CLAIM, RESPONSIBILITY, LIABILITIES, DEMANDS, OR CLAIMS OR ANY KIND ARISING OUT OF MY PARTICIPATION IN PILATES HAVEN TRAINING, PROGRAMS AND/OR EVENTS. I UNDERSTAND THAT THIS WAIVER IS INTENDED TO BE AS BROAD AND AS INCLUSIVE AS PERMITTED BY THE LAWS OF THE STATE OF CONNECTICUT.

By my signature I indicate that I have read and understand this Waiver of Liability. I am aware that this is a waiver and a release of liability and I voluntarily agree to its terms.

I am at least 18 years of age or my parent or guardian is signing this waver form on my behalf.

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