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Waiver

Complete the waiver before joining your first online class.

I am willingly participating in the online classes offered by Loïse Perruchoud at NeuroMotion Wellness. I recognize that the program may involve moderate to strenuous physical activity including but not limited to muscle strength and endurance training, cardiovascular conditioning and training and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation is purely voluntary. In consideration of my participation in this program, I hereby release Loïse Perruchoud, and its agents from any claims, demands and causes of action as a result of my voluntary participation and enrollment. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Loïse Perruchoud and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, strokes, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, injuries to knees or other joints of the body, injuries to back, injuries to a foot, heat prostration, or any other illness or soreness that I may incur.

By using this form, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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