Client Intake Form.

sarah.b.burton@gmail.com
+1 903.245.1653

2469 Earl Campbell Suite B
Tyler, TX 75701

Please sign your liability form at the front desk upon arrival to your first class or complete the one at the end of this page.

 

Liability.

GENERAL RELEASE AND INFORMED CONSENT

I hereby acknowledge that I am voluntarily participating in a physical conditioning and corrective exercise program based on the work of Joseph Pilates and the latest fitness research (the “Program”).  I hereby affirm that I (i) am in good physical condition, (ii) have my physician’s approval, and (iii) do not suffer from any undisclosed disabilities that would prevent or limit my participation in the Program.  In addition, I understand the potential risks of the Program after having had the opportunity to inquire in detail regarding all aspects of the Program, and to have all questions with regard to the Program satisfactorily answered, including physiological changes, which can occur. 

I, ALONG WITH MY HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS ASSIGNS, AND/OR REPRESENTATIVES (COLLECTIVELY “RELEASING PARTIES”), HEREBY FULLY AND FINALLY RELEASE AND AGREE TO PROTECT, INDEMNIFY AND HOLD HARMLESS STUDIO B PILATES PLUS BARRE, LLC, AND STUDIO B PILATES PLUS BARRE, LLC’S OFFICERS, AGENTS, EMPLOYEES. ATTORNEYS, SUCCESSORS AND ASSIGNS (AT TIMES, “RELEASED PARTIES”) FROM AND AGAINST ANY AND ALL CLAIMS, DEMANDS, CAUSES OF ACTION, LEGAL, EQUITABLE, OR OTHERWISE, AND DAMAGES, INCLUDING ATTORNEYS’ FEES, RESULTING FROM ANY ACCIDENT, INCIDENT OF OCCURRENCE ARISING OUT OF, INCIDENTAL TO OR IN ANY WAY RESULTING FROM THE PROGRAM (DEFINED ABOVE) ON STUDIO (b) PILATES PLUS BARRE, LLC’S PREMISES, WHETHER OR NOT CAUSED BY RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO RELEASED PARTIES’ NEGLIGENCE, GROSS NEGLIGENCE, AND/OR INTENTIONAL ACT OR OMISSION (OR ANY OTHER ALLEGED CULPABILITY). THIS RELEASE HEREIN APPLIES AT ALL TIMES. MOREOVER, I UNDERSTAND AND AGREE THAT THE INTENTION AND INTENDED EFFECT OF THIS RELEASE IS TO COMPLETELY, FULLY, AND FINALLY RELEASE ANY AND ALL CLAIMS AGAINST RELEASED PARTIES AND TO MAKE SURE THAT NO CLAIM(S) IS(ARE) EVER MADE AGAINST RELEASED PARTIES.

I further agree to indemnify and hold harmless Released Parties from any and all liability resulting from the injury or death of any person(s) or the damage to property that may result from my negligent, gross negligent or intentional act or omission while participating in the Program. 

I further understand and agree that, should I, or my heirs, executors, administrators, successors, assigns, and/ or representatives, ever institute any litigation arising out of this release, which I agree is a breach and in violation of this release and agreement, RELEASING PARTIES WAIVE ALL RIGHTS TO TRIAL BY JURY.  

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS RELEASE AND AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH THAT OCCURS WHILE PARTICIPATING IN THE PROGRAM AND THAT IT OBLIGATES ME TO INDEMNIFY THE RELEASED PARTIES FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT, GROSSLY NEGLIGENT, AND/OR INTENTIONAL ACT OR OMISSION WHILE PARTICIPATING IN THE PROGRAM. 

We have a 24-hour cancellation policy for all private and semi-private appointments. If you fail to show up for your appointment with less than a 24 hour notice, you will be charged the full price of your session to cover studio fees and the cost of your teacher’s time. No refunds. 

Group classes also have a 24 hour cancellation policy. This allows students on the wait list to have an opportunity to register. If you do not cancel your spot within 24 hours prior to class, your account will be charged.  No refunds.  

6 class passes for barre and TRX as well as 4 class passes for Pilates group equipment classes have a three month shelf life.