Samantha Eastwood - Pilates

RELEASE OF LIABILITY

I, the undersigned, am employing Samantha Eastwood for the purpose of instruction. In consideration of this instruction, I hereby release Samantha Eastwood and its agent and agree to hold them harmless from any and all liability, claims, damages, actions, irrespective of how arising and however caused, including but not limited to all kinds and degrees or extent of negligence with which Samantha Eastwood may be charged in connection directly or indirectly, with those volunteering to be a demonstration patient. I further agree to disclose in writing below, all of my physical and medical conditions limitations and sensitivities, and agree to release and hold Samantha Eastwood harmless from any liability, claims, damages, action and causes of action in any way relating to or arising from said conditions, limitations or sensitivities. I further agree Samantha Eastwood, its agents shall not be liable for any claims, demands, injuries, damages or cause of action whatsoever arising out of, or connected with the use of any of its services, facilities or equipment. I hereby expressively forever release and discharge Samantha Eastwood from all such claims, demands, injuries, damages, actions or causes of all action, and from all acts of active or passive negligence on the part of Samantha Eastwood.

Name

First Name

Last Name

Date Signed

YYYY

Electronic Signature Authorization

By checking this box and typing my name below, I am electronically signing this Release Of Liability form.

Signature

Physical or Medical Conditions

Yes

List Conditions

If you answered "Yes" in previous question, list conditions below.