1. Tell us about yourself:

    2. Please provide the details for an Emergency Contact Person
    in the unlikely event of a natural disaster or accident/personal injury.

    3. Liability Waiver

    Please be aware of your body. Let us know what medical problems you may have, including but not limited to;
    Heart Trouble, Diabetes, Hypoglycemia, Asthma, Lower back pain, High or low blood pressures.
    If you have had recent surgery, or are pregnant, you should not participate without a written consent from your doctor.

    I acknowledge that I should inform each instructor of any physical limitations, problems or conditions that would adversely affect my ability to participate in any strenuous exercise without further injury. I will abide by my instructors decision regarding my participation.
    ​
    I further agree to inform the instructor of any injury or unusual pain suffered by me during the following class. I understand that in any program of strenuous exercise, there is some risk of injury, despite the best efforts of the professional instructors and employees and I am willing to assume all risks.

    Therefore I hereby release for myself, my heirs, my executors and administrators NiaTechnique Inc., Helene Purcell, her employees, contractors and colleagues, from all claims, liabilities, expenses or judgments arising out of my participation in Nia classes or workshops.
    Photographic Image Release:
    ​I agree that by participating in a Nia activity I allow photographic images to be recorded and I give permission for images including myself to be published for Nia promotional purposes.
    I have carefully read and understand the foregoing provisions. By selecting the 'Agree' tick box, I hereby certify and acknowledge that I understand all the terms of this contract and agree to be legally bound by the terms and conditions set forth in the specific provisions.