SECTION A:
Child Participant(s) First Name:
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Child Participant Last Name:
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Name of Parent(s)/Guardian (if applicable) otherwise type "N/A":
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Email
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Mobile Phone:
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Address:
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City:
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Postal Code:
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Yes, I want to have access to tools, information and strategies for family empowerment and growth, plus free stuff!
No thanks I don't want more empowerment information.
SECTION B: TICKET PRICE / ADMISSION FEE:
Workshop Investment:
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BACK TO SCHOOL MINDSET PREP
$79.00 CAD
$
79.00
CAD
WORKSHOPS AND COACHING PROGRAMS ARE NON-REFUNDABLE.
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Total
$0.00 CAD
$
0.00
CAD
SECTION C
: Liablity Waiver and Disclaimer
ALL PARTICIPANTS PLEASE READ AND SIGN (TYPE SIGNATURE BELOW):
Glossary: "Event Host" refers to The Confidence Coach, Ashley Anjlien Kumar, South Asian Arts Movement Society, The Balance Code Yoga & Wellness Ltd and associated affiliates, guest presenters, sponsors or facilitators. Assumption of Risk of Injury and Wavier of Claims: I assume all risks of injury and waive all rights to pursue money damages or any other relief of any kind as a result of anything occurring at or near the location wherein I shall engage in activities offered by the Event Host or any other venue used by the Event Host or its employees, officers, directors or other representatives (including but not limited to dance, fitness, yoga, personal development, music, singing, arts or craft type instructors and/or artists associated with the Event Host and/or contractors of any type). In the event I am injured while on a property the Event Host uses to conduct events, classes, performances, or workshops, I will hold harmless the Event Host and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, family members, successors and assigns from all claims of any sort for damages or relief, including but not limited to claims for contribution. I acknowledge there is possible danger connected with any physical activity (including the dangers of physical injury and death) and knowingly and voluntarily waive my right to make a legal or equitable claim of any sort against the Event Host and any affiliates or sponsors, and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, family members, successors and assigns from all claims of any sort for damages or for other relief, including but not limited to claims for contribution. This assumption of risk and wavier of liability applies to my family members, successors, heirs, and assigns. Physical Condition and No Medical Advice: I represent that I am in good physical condition and have no medical reason or impairment that might prevent me from my participation or intended use of the services or products offered by the Event Host. I acknowledge that the Event Host and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, family members, successors and assigns will not and cannot provide me medical advice relating to my physical condition and ability to use the facilities/participate in programs/classes, events or workshops. If I have any health or medical concerns now or after registering for an event, class or workshop, I will discuss them with my doctor before attending & participating in any classes, events or workshops conducted by the Event Host or using the Event Host's services or products. I acknowledge that Life Coaching Programs are not a replacement for nor do they represent medical or psychological advice; I understand that I take full responsibility for my mental and emotional health; I agree that Life Coaching programs are intended to provide helpful information and not intended to replace the advice of any clinical medical or psychological / psychiatrists’ advice. Death/Disability Clause: If I die or become totally or permanently disabled, upon reasonable written notice to the Studio/Club Owner of the death or disability, either I or my estate may cancel this agreement and receive a pro-rata refund for my unused sessions/classes. Cancellation and Refund: All event and workshop registrations are FINAL SALE; if for some reason I am not able to attend or participate, I may transfer the registration to a friend or family who will attend in lieu, PRIOR to my actual attendance in the program, event, class or workshop; I will notify the Event Host in writing in this case with FULL DETAILs; transfer-ability is VOID once the program, event, class or workshop has started; I understand that the Event Host has the FULL RIGHT to deny any transfer of registration or cancel my registration at any time. I, the undersigned, waive and release the Event Host and its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, family members, successors and assigns from any and all claims in any way connected with my participation. This agreement is binding on my heirs and executors. I understand that ALL aspects of this wavier apply to any children that are participating in the program, classes, workshop, or event, and any children or minors that I bring with me to any of the classes, programs, events, workshops or gatherings offered by Event Host. I acknowledge that I am the legal guardian of the child(ren) listed on this form (if any). By signing this document, I acknowledge that I have read or heard this document in its entirety and that I fully understand it. I have asked any questions that may have occurred to me and have been answered to my satisfaction. A legal guardian/parent must sign for any participants under the age of 18 years. Your typed signature below will be considered identical to your actual signature if this form is submitted electronically.
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Signature
Date Signed:
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Month
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Day
Year
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Please remember to bring your own water bottles, yoga mat (if needed), and clean indoor fitness shoes if needed. (not applicable for online workshops)
How did you hear about us?
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I understand and agree to provide consent of photos and videos to be taken during the event, class, workshop or program which may used for promotional or marketing purposes by the Event Host. If you have very specific concerns about this, please indicate in the comments; we honor and respect your privacy.
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Yes
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