Waiver/PARQ

CLEAR FORK PILATES
by Movement Integration Studio LLC

Please Read, Sign, and or Electronically Acknowledge the following policies prior to attending classes-required at booking.

PHYSICAL ACTIVITY READINESS QUESTIONAIRE (PARQ)
PART 1. PARQ

Participant Informed Consent, Health Declaration (PAR-Q), Assumption of Risk, Liability Waiver & Terms and Conditions Agreement

This Agreement is entered into between the undersigned participant (“Participant”) and Movement Integration Studio LLC, doing business as Clear Fork Pilates (“Studio”).

INFORMED CONSENT
I understand that Movement Integration Studio LLC DBA Clear Fork Pilates provides Pilates instruction, Somatic Movement education, fitness classes, workshops, teacher training programs, educational courses, observation opportunities, self-practice sessions, private instruction, and related movement-based activities.

These activities may include, but are not limited to:

  • Reformer Pilates
  • Chair Pilates
  • Trapeze Table/Tower Training
  • Ladder Barrel/Spine Corrector and Arcs
  • Mat Pilates to include props and accessories
  • Somatic Movement Education
  • Workshops and Continuing Education
  • Pilates Teacher Training Programs
  • Observation and Practice Teaching Sessions
  • After-hours marketing events and Pilates-related activities

I understand that participation involves physical exertion and carries inherent risks including, but not limited to:

  • Muscle soreness
  • Muscle and ligament sprains, strains and tears
  • Joint injuries
  • Falls
  • Bruising
  • Dizziness
  • Temporary aggravation of existing conditions
  • Serious injury/Disability
  • Death

I acknowledge that instructors, educators, assistants, resident teachers, and contractors are not acting as physicians, physical therapists, chiropractors, psychologists, or other licensed healthcare providers unless specifically stated.

I understand that no guarantees have been made regarding fitness improvements, health outcomes, rehabilitation, pain reduction, weight loss, or educational outcomes.

I voluntarily choose to participate in all activities offered by the Studio.

Participant Initials: ________

HEALTH DECLARATION AND PARTICIPATION READINESS
I acknowledge that participation in Pilates, Somatic Movement, fitness activities, workshops, teacher training programs, observation sessions, self-practice sessions, and educational activities provided by Movement Integration Studio LLC DBA Clear Fork Pilates requires a reasonable level of physical health and personal responsibility.

I represent and warrant that I am physically capable of participating in Studio activities and that I have either:

(a) consulted with my physician or qualified healthcare provider regarding my participation; or

(b) voluntarily chosen to participate without seeking such consultation and accept full responsibility for that decision.

I understand that it is my responsibility to disclose any condition that may affect my ability to participate safely, including but not limited to:

  • Heart or cardiovascular conditions
  • High or low blood pressure
  • Respiratory conditions
  • Neurological disorders
  • Dizziness, fainting, or balance concerns
  • Pregnancy or postpartum recovery
  • Recent surgeries or hospitalization
  • Joint, bone, muscle, connective tissue, or spinal conditions
  • Chronic pain conditions
  • Any injury, illness, disability, or medical condition that may be aggravated by physical activity

I agree to immediately notify the Studio of any changes in my health status, medical condition, pregnancy status, injury, surgery, or medication that may affect my participation.

I understand that instructors, educators, resident teachers, assistants, and staff of Movement Integration Studio LLC DBA Clear Fork Pilates are not medical professionals and do not diagnose, treat, prescribe, or provide medical advice.

I understand that failure to disclose relevant health information may increase my risk of injury and may limit the Studio’s ability to provide appropriate exercise modifications.

Please list any medical conditions, injuries, surgeries, medications, pregnancy status, or physical limitations that may affect your participation. If none, write “None.”

Participant Initials: ________

ASSUMPTION OF RISK
I acknowledge that participation in Studio activities carries risks that cannot be completely eliminated regardless of the care taken by Movement Integration Studio LLC DBA Clear Fork Pilates.

I knowingly and voluntarily assume full responsibility for all risks, known and unknown, associated with my participation.

I understand that participation is entirely voluntary and that I may discontinue participation at any time.

Participant Initials: _______

RELEASE AND WAIVER OF LIABILITY
In consideration of being permitted to participate in activities provided by Movement Integration Studio LLC DBA Clear Fork Pilates, I hereby release, waive, discharge, and hold harmless:

  • Movement Integration Studio LLC
  • Clear Fork Pilates
  • Its owners, members, officers, and directors
  • Resident teachers and instructors
  • Educators and assistants
  • Volunteers
  • Landlords and property owners
  • Successors and assigns

from any and all claims, demands, actions, causes of action, damages, losses, liabilities, costs, expenses, attorney fees, or judgments arising from or related to my participation in Studio activities, including personal injury, property damage, illness, disability, or death, except where prohibited by law or caused by gross negligence or willful misconduct.

Participant Initials: _______

MEDICAL TREATMENT AUTHORIZATION
Should an injury, illness, or emergency occur, I authorize Movement Integration Studio LLC DBA Clear Fork Pilates to seek emergency medical treatment on my behalf when deemed necessary.

I understand that I am solely responsible for any resulting medical costs, ambulance fees, hospital charges, or treatment expenses.

Participant Initials: _______

TERMS AND CONDITIONS
I agree to the following:

  1. I will disclose relevant injuries, medical conditions, pregnancy status, surgeries, and health concerns to my instructor.
  2. I will immediately stop participation and notify an instructor if I experience pain, dizziness, shortness of breath, nausea, or discomfort.
  3. I understand that Pilates equipment requires careful use and adherence to instructor directions.
  4. I agree to follow all Studio rules, policies, safety procedures, and instructor guidance.
  5. I understand that classes, schedules, instructors, programming, pricing, and services may change without notice.
  6. I understand that memberships, packages, teacher training programs, and educational offerings may have separate enrollment agreements and cancellation policies.
  7. I accept responsibility for my personal belongings and understand the Studio is not responsible for lost, stolen, or damaged property.
  8. I agree to conduct myself respectfully toward staff, instructors, students, members, and guests.
  9. The Studio reserves the right to refuse service, remove participants from activities, or terminate memberships for unsafe, inappropriate, disruptive, or abusive conduct.
  10. I understand that participation in observation, practice teaching, workshops, educational programs, and teacher training activities is subject to the same risks and protections outlined in this Agreement.

Participant Initials: _______

PHOTOGRAPHY, VIDEO AND MEDIA CONSENT

I understand that photographs, video recordings, audio recordings, livestreams, and other media may be captured during classes, workshops, educational programs, events, teacher training courses, observation sessions, and other activities conducted by Movement Integration Studio LLC DBA Clear Fork Pilates.

By signing/initializing this Agreement and participating in Studio activities, I expressly grant Movement Integration Studio LLC DBA Clear Fork Pilates, its employees, contractors, educators, and representatives, permission to capture, use, reproduce, publish, display, and distribute my image, likeness, voice, and appearance for lawful business purposes, including:

  • Marketing and advertising
  • Social media platforms
  • Studio websites
  • Printed materials
  • Educational content
  • Promotional campaigns
  • Public relations activities

I understand that no compensation will be provided for such use.

This consent shall remain in effect for all current and future participation with the Studio unless I provide written notice withdrawing my consent. I understand that withdrawal of consent will apply only to future use and will not require the removal of materials already published or distributed.

If I do not wish to be photographed or recorded, I agree to notify the Studio in writing prior to participation.

Participant Initials: _______

 

ACKNOWLEDGEMENT AND AGREEMENT

I certify that:

  • I have read this entire document.
  • I understand its contents.
  • I have had the opportunity to ask questions.
  • I understand that I am waiving certain legal rights.
  • I sign this Agreement voluntarily and without coercion.
  • I understand this Agreement shall remain in effect for all current and future participation unless revoked in writing and accepted by the Studio.

Participant Signature:

______________________________________________________________________________

Date: _______________________________

Parent/Guardian Signature (if under 18):

______________________________________________________________________________

Date: _______________________________

Studio Representative:

______________________________________________________________________________

Date: _______________________________

 

BY INITIALING THIS BOOKING, I ACKNOWLEGE THAT I HAVE READ AND AGREE TO THE WAIVER, INFORMED CONSENT, HEALTH DECLARATION, MEDIA CONSENT AND TERMS AND CONDITIONS ABOVE. MY INITIALS ON STUDIO BOOKINGS FORM SERVE AS MY ELECTRONIC SIGNATURE.

 

 

Name_____________________________________Date: ___________________