v1.4

NEW STUDENT
REGISTRATION FORM

Registration Date *
Full Name *
Name as per HKID/Foreign Passport
first name
last name
nick name
Gender *
Date of Birth *
day
month
year
HKID / Foreign Passport No *
Phone *
Email *
Address *
Occupation *

Emergency Contact Information

Name
Relationship
Phone
Email

Other Information

How did you find out about Be Earth? *
Yoga Experience *
Most Interested In *
Please tick all relevant health history *
Please Note: If you answer yes to any of the above marked with an asterix * ,a note from your health practitioner allowing you to participate in any yoga/pilates/barre/reformer or fitness related activity is mandatory. You are not permitted to attend a Be Earth Yoga class until clearance is obtained.
If you ticked any of the above, please provide further details:
Do you have any injuries or recent surgeries that may restrict your yoga/pilates/barre/reformer practice? *
If yes, please provide details:
Are you pregnant, or have you given birth in the last six months? *
If yes, please provide details:
What do you wish to learn or achieve from your yoga/pilates/barre/reformer practice? *

RELEASE AND WAIVER OF LIABILITY

I hereby agree to the following:
1. I am participating in yoga , pilates, barre and reformer classes, health programs, workshops and other wellness, exercise and healing arts activities (collectively, the “Activities”) offered by Be Earth (“Studio”) and/or its owners, instructors, teachers, workshop presenters, employees and independent contractors.

2. I recognize that I must be in good physical and mental health to participate in the Activities. I understand that the Activities require physical exertion, and I represent and warrant that I am physically fit and I have no medical condition, which would prevent my full participation in the Activities. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Activities. If I have consulted a physician, I have taken the physician’s advice. I understand that the Studio reserves the right in its absolute discretion to refuse my participation in an Activity on medical, fitness or other grounds.

3. I am in proper physical condition to participate in the Activities, and I am aware that participation could, in some circumstances, result in abnormal blood pressure, fainting, heartbeat disorders, physical injury and potentially heart attack. I also understand that I could experience muscle, back and other injuries during exercise. I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured. I understand that it is my continuing responsibility to inform the Studio of any previous medical conditions, injuries or surgeries prior to my first class and any future changes to my medical condition.

4. In consideration of being permitted to participate in the Activities, 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 Activities at the Studio.

5. In further consideration of being permitted to participate in the Activities, I knowingly, voluntarily and expressly waive any “Claim” (as defined below) I may have against the Studio, its owners, members, employees, and/or its instructors, teachers, volunteer staff, interns, workshop presenters, independent contractors and the landlord of the Studio (each, a “Released Party”) for any Claim that I may sustain as a result of participating in the Activities at the Studio even if the Claim arises from the negligence of any Released Party or anyone else. I agree to indemnify and hold harmless each Released Party from any loss or liability incurred in defending any Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or did result from the negligence of any Released Party or anyone else. “Claim” includes but is not limited to any and all liabilities, claims, demands, expenses, fees, legal actions, rights of actions for damages, personal injury, mental suffering and distress, or death that I may suffer, my children may suffer or that my unborn child may suffer (including any legal fees or expenses) in connection with participation in any Activity.

6. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any Released Party for any Claim caused by any negligence or other acts of a Released Party.

7. I hereby understand that the Studio from time to time may photograph or video classes or events occurring at its studios and place such photographs and videos on its Website. I hereby consent to the use of my image that may appear in any such photograph or video.

8. I understand the Studio will not be responsible for any items damaged, lost or stolen on its premises for any reason whatsoever, including but not limited to any property left in a locker, whether locked or unlocked. I, shall be solely responsible for taking care of my personal belongings on the premises.

9.Lockers are provided for day use at no cost and shall be emptied at the end of the day and the Studio shall be entitled to break open any such locker which remains unopened and/or unemptied at the end of each day and remove the contents of such locker.

10.Lost property found on the premises will be held by the Studio for a period of seven (7) days, after such time the Studio reserves the right to dispose of the items in any way it sees fit, no claims shall valid after this period.

11.I declare all of the information provided by me to be correct to my knowledge and have not withheld any information that may result in any consequences.

12.I acknowledge that the Studio may at its sole discretion amend, vary, delete or add to these Terms and Conditions with immediate effect. Any changes will be advised by notification on the Studio’s Notice Board.

13.This agreement shall be construed in accordance with, and governed by, the laws of the Special Administrative Region of Hong Kong. I acknowledge that I have carefully read this release and waiver of liability and fully understand its contents. I voluntarily and knowingly agree to the terms and conditions stated herein. I am aware that by signing this release and waiver of liability, I am giving up substantial rights, including my right to sue and certain legal rights my heirs, next of kin, executors, administrators and assigns may have against any Released Party.
By signing this agreement, I agree with the above terms and conditions

I am the parent or legal guardian of [ ] , a minor, and on the minor’s behalf, and on my own behalf, and on the behalf of all other parents or guardians of the minor, I accept the release and waiver of liability at the top of this form as inducement for allowing my child, or this minor to participate in the Yoga/Pilates/Barre/Reformer Classes, Health Programs, and Workshops offered by Be Earth.

Full Name
Email
Phone

Staff Use員工填寫

Staff Name *
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