CERTIFICATE OF INSURANCE

Electronic Waiver Form Revive of Soul

I,
First name:________________________________________
Last name:________________________________________
hereby agree to the following:

1. That I am participating in the Classes, Health Programs, or Workshops (the "Programs") offered by Revive of Soul Wellness and Spa Studio,Inc and Anastasia Ovoshchnikova as instructor (“Revive of Soul"), during which I will receive information and instruction about fitness, pilates, body movement and health. I recognize that fitness, pilates training requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that there are physical and inherent risks involved in the Programs, including the risk of serious physical injury and death. I fully assume all risks associated with the Programs, including: intensive activity and exertion, causation or aggravation of a physical injury or medical condition, lack of warnings or inadequate warnings; lack of instructions, inadequate instructions, or my failure to follow instructions; slipping from slippery surfaces such as mats or floors; equipment failure; and the like. I am fully aware of and accept the risks and hazards involved, and agree to assume full responsibility for any risks, conditions, injuries or damages, known or unknown, which I might incur or aggravate as a result of my participating in the Programs.

3. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Programs. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Programs.

4. In consideration of being permitted to participate in the Programs, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the Programs.

5. In further consideration of being permitted to participate in the Programs, I knowingly, voluntarily and expressly waive any claim I may have against Revive of Soul for injury or damages that I may sustain as a result of participating in the Programs.

6. I, for myself and my heirs, assigns, successors, executors, administrators, and legal representatives hereby release, and agree that I will not sue Revive of Soul, its Affiliates, Officers, Directors, Agents, Servants and Employees, or the landlord of any premises at which Revive of Soul may operate, for money damages for personal injury or property damage sustained by me during my use of, presence in, and/or participation in the Revive of Soul facilities, equipment and Programs.

7. I, for myself and my heirs, assigns, successors, executors, administrators, and legal representatives hereby agree I will defend, indemnify and hold harmless Revive of Soul, its Affiliates, Officers, Directors, Agents, Servants and Employees, or the landlord of any premises at which Revive of Soul may operate, from any and all claims, suits or demands by anyone arising from my use of, presence in, and/or participation in the Revive of Soul, equipment and Programs.

8. I also understand that, except for a monetary refund, I have no claim against Revive of Soul, or the landlord of the premises (except for the monetary refund), by reason of their refusal to allow me to participate in the Programs.

9. I understand that it is my continuing responsibility to inform the instructor(s) at Revive of Soul, of any previous medical conditions, injuries or surgeries prior to my first class and at such other times as I acquire information as to same. Please list any current or previous conditions, ailments, injuries and/or surgeries:

____________________________(Signature) ______________(Date)

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