Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Release of liability *

I am aware that participation in physical exercise may result in accident or injury, and I assume the risk connected with the participation in physical exercise and represent that I am in good health and suffer from no physical impairment which would limit my use of GYROTONIC® equipment or my ability to exercise. I acknowledge that Clare Cleveland has not and will not render any medical services including medical diagnosis of my physical condition. I specifically agree that Clare Cleveland, her officers, employees and agents shall not be liable for any claim, demand, cause of action of any kind whatsoever for, or on account of personal injury, illness, death, property damage or loss of any kind resulting from or related to my use of the facilities or participation in exercise or activity within or without Clare Cleveland’s premises, and I agree to hold Clare Cleveland harmless from same.

I have read and fully understand the liability waiver and agree with all the terms and conditions stated herein.

Cancellation Policy *

The deposit for the Level 1 GYROTONIC® Pre-Training course is non-refundable. The balance for the course is due on the first day of the training. Once the course begins, there are no refunds. If a life-changing event causes you to be unable to continue with the program as scheduled, you must arrange to work privately with your Pre-Trainer in order to complete the training and be eligible to proceed to Foundation Training. If you miss 1 day or more of the training, you must make it up in private session(s) in order to be eligible to proceed to Foundation Training. Privates will be scheduled around the instructor’s availability at the regular private session rate.

I have read and fully understand the cancellation policy and agree with all the terms and conditions stated herein.

Date of agreement *

MM

DD

YYYY