Release Form Date MM slash DD slash YYYY Name(Required) First Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Cell Phone(Required)Emergency Contact Name(Required) First Last Emergency Contact Phone(Required)Emergency Contact Relationship(Required) SurgeriesFor your safety and for us to better serve you during class or private lessons, please list any surgeries or injuries you have had the we should be aware of.Fluid Form AgreementI acknowledge the above agreement and agree(Required) I Agree RELEASE OF LIABILITY, WAIVER, AND ASSUMPTION OF RISK ACKNOWLEDGEMENTI acknowledge the above Liability Release and agree(Required) I Agree Payment Policy(Required)Member acknowledges and agrees that all payments must be prepaid through the MindBody Software, or other such mechanism as determined by Fluidform in its sole and exclu-sive discretion, prior to attending the class and/or session. Single Class in 4-pack purchases expire thirty (30) days after the date of the purchase. Package 8-pack to 24-pack purchases expire ninety (90) days after the date of purchase. All packages are priced individually and are nonrefundable and nontransferable. I agree to the payment policyCancellation Policy(Required)Member acknowledges and agrees that they will be charged for a full session if they fail to attend a scheduled session or provide notice of cancellation of less than-twenty four (24) hours in advance of the scheduled session. I agree to the cancellation policySignature(Required)
