Exercise Registration Form

First Name *

First Name

Last Name

D.O.B *

MM

DD

YYYY

May we send you emails?

Yes

No

Phone *

(###)

###

####

May we send you texts? *

Yes

No

Emergency Contact Phone *

(###)

###

####

Are you pregnant?

Please inform Hara Studio if you become pregnant so we can modify exercises for you.

Yes

No

When are you due?

MM

DD

YYYY

May we use hands on techniques with you? *

Yes

No

May we take photos / video of you for social media? *

Yes

No

Do you agree to be filmed for online live classes? *

Yes

No

I take full responsibility for my actions at any and all times at HARA- beyond movement studio during any workouts, classes, practice and use of equipment in any way whilst engaged in activities in the studio, online or at a guest premises. I agree to keep my instructor updated as to any changes in my medical profile and that there shall be no liability on the instructor if I fail to do so. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against HARA Beyond Movement Studio its employees or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. *

I Agree.