REGISTRATION FORM

Please print and mail to:  Leda Elliott, 23 Grosvenor Park, Lynn MA 01902
or bring this on the first day of your course.

 

Name  
Program Name  
Date of workshop  
Location  
E-mail
Address  
   
Phone  
Injuries  
   

 

 

RELEASE OF LIABILITY IN CASE OF INJURY

I understand that I am responsible for monitoring my own condition throughout the exercise program and should any unusual symptoms occur, I will cease my participation and inform the instructor of the symptom.  In consideration for being allowed to participate in Leda Elliott’s  exercise program, I agree to assume the risk of such exercise, and further agree to hold harmless  Leda Elliott and her staff members conducting the exercise program from any and all claims, suits, losses or related causes of action for damages, including, but not limited to, such claims that may result from my injury or death, accidental or otherwise, during, or arising in any way from the exercise program.

 

Signature of participant                                                   Date