Client Waiver

Please review the Casatelier Client Waiver before attending your first class.

Important: This page is provided for review only. No information or signature is collected on this page.
Download Waiver Form
01

Health Questionnaire

View Health Questionnaire +

First Name Last Name Email Address Phone Number Address

Have you ever been advised by a doctor to avoid exercise? Please explain: Do you take any prescribed medications? Please list:

Do you take any over-the-counter medications? Please list:

Do you have, or have you ever had, a breathing problem? Asthma? Please explain: Do you now smoke, or have you ever smoked? Moderately or heavily? For how long? Do you have, or have you ever had, a heart or lung problem? Please explain:

Do you have any orthopedic problems (i.e. bone, ligament, tendon, joint, muscle, etc.)? Please explain:

Do you have, or have you ever had, any back or neck pain or problems? Please explain: Do you have any type of arthritis, bursitis, or tendinitis? Please explain:

Do you have osteoporosis? Please explain:

Do you have high blood pressure? Are you taking medication for it?

Do you have low blood pressure? Are you taking medication for it? Please list all medications:

Are you pregnant or believe you may be pregnant? If you are pregnant has your doctor cleared you to engage in Pilates exercises and training. If yes, has your doctor recommended any limitations on such exercises or training. If yes, please explain:

Do you have any allergies? Are you taking medication for them? Please list all medications: Are you under an extreme amount of stress? Please explain:

Are you on any type of special diet at this current time? Do you have any eating disorders? Please explain:

Do you have, or have you ever had, any injuries (including minor)? Please describe and give date:

Have you ever had any surgeries? Please describe and give date:

What do you currently do on a regular basis for physical fitness? Please be specific, giving frequency and duration:

What are your main reasons for enrolling in this program?

What do you currently do on a regular basis for physical fitness? Please be specific, giving frequency and duration:

What are your main reasons for enrolling in this program? Write your full name and date.

If any of your answers to the above questions are “YES”, you should have a physical examination and consult your doctor prior to beginning this exercise program. After reading the afore information, I understand the need for a physical examination prior to beginning an exercise program. Realizing that the results of such an exam might indicate that I should not

begin such an exercise program. - If you elect to have a physical examination do not check boxes below and consult you doctor before exercise program.

Is there any history of any of the following conditions in your immediate blood relatives (i.e. parents, grand- parents, siblings)? Check all that apply:

ATTIRE AND EQUIPMENT: Grip socks are required for all reformer/Xformer classes and are recommended (but not required) for mat classes. For mat classes, participants are required to bring and use a yoga mat. Appropriate athletic attire is required for all classes.

Back to contents ↑
02

Liability Waiver

CASA DE PILATES, LLC d/b/a Casatelier

ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

In consideration of being permitted by Casa de Pilates, LLC, a California limited liability company d/b/a Casatelier (herein referred to as “CASATELIER” or “CASATELIER”) to participate in the “Activities” (defined below) and to use the equipment and facilities of CASATELIER, now and in the future, I, the undersigned, on behalf of myself, (and if applicable) my child or ward (both of us hereinafter referred to as “I” or “Client”), my spouse, parents, siblings, heirs, estate, insurers and assigns and if applicable the parents, siblings, heirs, estate, insurers and assigns of my child or ward (collectively, the “RELEASING PARTIES”) hereby agree as follows:

  1. Assumption of Inherent Risks and Dangers. I acknowledge and agree that engaging or participating in Pilates exercises and training (including, without limitation, reformer/Xformer Pilates, mat Pilates, hybrid yoga/Pilates classes, recovery and stretching classes, and one-off dance, cardio and similar fitness classes), whether using CASATELIER equipment or a participant’s own yoga or exercise mat, both at the CASATELIER facilities and on my own following the instructions of CASATELIER’s instructors, and taking instruction in Pilates exercises and training provided by CASATELIER and its instructors (collectively, the “Activities”) entail certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the Activities and regardless of the care taken by CASATELIER. Those risks include, among others, (i) physical injury, which could be temporary or permanent, such as spraining or breaking ankles and wrists, breaking of other bones, pulling or tearing ankle, leg, arm, neck and other muscles, tendons and ligaments, dislocating shoulders, injury to eyes which could result in loss of vision, miscarriage, among other physical

injuries, (ii) exposure to and contracting communicable, infectious or other illnesses or deceases such as COVID-19, flu, common colds, among other viruses, fungi and bacteria infections, illnesses and diseases, (iii) psychological injury, (iv) pain and suffering, (v) temporary or permanent disability,

(vi) paralysis, (vii) death, (viii) property loss or damage and (ix) financial loss. I hereby assert that my, and if applicable my child’s or ward’s, use of the CASATELIER facilities and equipment and participation in the Activities is voluntary and that I/we knowingly assume all inherent risks of participating in the Activities and agree to the releases, waivers, limitation of liability and indemnities provided below.

  1. Client (and if applicable, my child or ward) hereby expressly waives and releases any and all claims which Client (and if applicable, my child or ward) may have, or which Client (and if applicable my child or ward) may hereafter have, whether known or unknown, against the CASATELIER, and its owners, members, shareholders, partners, employees, independent contractors, agents, affiliates, officers, directors, managers, successors and assigns (collectively together with CASATELIER, the "RELEASED PARTIES"), on account of injury, miscarriage, disability, death or loss arising out of or attributable to my participation in the Activities (and if applicable, the participation of my child or ward), whether arising out of the ordinary negligence of the RELEASED PARTIES or otherwise. Client (and if applicable my child or ward) covenants not to make or bring any such claim against the RELEASED PARTIES, and forever releases and discharges the RELEASED PARTIES from liability under such claims. This waiver and release does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities that California law does not permit to be released by agreement.

I understand that by signing this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement, I am waiving for myself (and if applicable on behalf of my child or ward) any and all claims, of any kind arising out of or attributable to my participation (and if applicable the participation of my child or ward) in the Activities, including those claims that may be unknown to me (and if

applicable, my child or ward), or which I do not suspect (and if applicable, my child or ward does not suspect) to exist at this time. WITH THE INTENTION OF WAIVING ALL UNKNOWN AND UNSUSPECTED CLAIMS, I HEREBY EXPRESSLY WAIVE (AND IF APPLICABLE, EXPRESSLY WAIVE ON BEHALF OF MY CHILD OR WARD) ALL RIGHTS, BENEFITS, AND PROTECTIONS I MAY HAVE UNDER CALIFORNIA CIVIL CODE SECTION 1542, WHICH READS AS FOLLOWS:

A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.

  1. Liability Limitation. Client (and if applicable, my child or ward) agrees that if the waivers and releases set forth in Paragraph 2 above are not enforceable, then regardless of the actual or alleged cause of any injury, death or loss, the liability of the RELEASED PARTIES in connection with the participation in the Activities and the use of the equipment and facilities of CASATELIER, resulting from any negligent acts, errors and/or omissions of CASATELIER or any of the other RELEASED PARTIES is limited to the total fees actually paid by the Client to CASATELIER for services rendered by CASATELIER and any of the other RELEASED PARTIES hereunder.

  2. Indemnification. The RELEASING PARTIES hereby agree to, release, hold harmless, defend and indemnify the RELEASED PARTIES (i.e., defend and pay any judgment and legal costs and expenses, including, without limitation, attorney’s fees and other expenses) from any and all claims of any or all of the RELEASING PARTIES arising from my and if applicable, my child’s or ward’s death, injury or loss due to the use of the facilities and equipment of CASATELIER and the participation in Activities and related presence on the premises of CASATELIER by me and, if applicable, my child or ward (including, without limitation, those arising from the inherent risks of the Activities or the ordinary negligence of any or all of the RELEASED PARTIES or other third parties, including, without

limitation, other attendees and clients of CASATELIER at the CASATELIER facilities. The RELEASING PARTIES further agree to hold harmless, defend and indemnify the RELEASED PARTIES against any and all claims of co-clients of CASATELIER, rescuers and others arising from my (and, if applicable, my child’s or ward’s) conduct in the course of use of the facilities and equipment of CASATELIER and the participation in Activities and related presence on the premises of CASATELIER by me and if applicable my child or ward.

  1. Mediation or Arbitration. I agree that if any dispute shall arise from this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement or from my (or if applicable, my child’s or ward’s) use of the facilities and equipment of CASATELIER or participation in the Activities and related presence on the premises of CASATELIER by me (and if applicable, my child and ward) I shall first engage in good faith efforts to mediate the dispute. Any agreement reached will be formalized by a written agreement at that time. Should the issue not be resolved by mediation, I agree that all claims and disputes arising under or relating to this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement or the use of the facilities and equipment of CASATELIER or participation in the Activities and related presence on the premises of CASATELIER by me (or if applicable, my child or ward) are to be settled by binding arbitration in the state of California. The arbitration shall be conducted on a confidential basis pursuant to the Comprehensive Arbitration Rules of the JAMS. Any decision or award as a result of any such arbitration proceeding shall be in writing and shall provide an explanation for all conclusions of law and fact. Any such arbitration shall be conducted by one arbitrator who shall be a retired judge of any California Court or Federal Court located in the State of California. An award of arbitration may be confirmed in any California State Court of competent jurisdiction. The arbitrator’s award shall be in writing and provide a written statement of the essential findings and conclusions. The arbitrator shall not have the power to commit any error of law or legal reasoning, and the award may be vacated or corrected on appeal to a court of competent jurisdiction for any such error. This arbitration provision is subject to the

California Arbitration Act, and may be enforced in any California State Court of competent jurisdiction located in the State of California.

  1. Severability. I further expressly agree for myself (and if applicable, on behalf of my child and ward) that this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect.

  2. Choice of Law. This Agreement shall be interpreted and construed under and governed by the laws of the State of California, without giving effect to that State’s choice of law rules.

  3. Acknowledgement of Understanding. I have read this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement and fully understand its terms. I understand that I am giving up substantial rights, including, without limitation, my rights, (if applicable) the rights of my child or ward, and the rights of the RELEASING PARTIES to sue for damages in the event of death, injury or loss. I acknowledge that I am signing this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement freely and voluntarily, and intend by my signature below, that this Agreement be a complete and unconditional release of the RELEASED PARTIES from all liability, including, without limitation, that due to inherent risks of the activities described herein and the ordinary negligence of the RELEASED PARTIES to include any and all claims for actual or alleged failure to supervise and oversee the Activities, to the greatest extent allowed by the laws of the State of California.

  4. Misrepresentation and Fraudulent Execution of This Agreement. I AGREE TO INDEMNIFY THE RELEASED PARTIES FOR ALL LIABILITY AND CLAIMS, INCLUDING, WITHOUT LIMITATION, ATTORNEY’S FEES, ARISING FROM ANY MISREPRESENTATIONS OR

FRAUDULENT EXECUTION OF THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT.

  1. Application of this Agreement. I ACKNOWLEDGE THAT THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT WILL APPLY FOR EACH AND EVERY TIME I OR MY CHILD OR WARD ATTENDS CASATELIER’S FACILITIES, USES ANY OF ITS EQUIPMENT OR FACILITIES OR PARTICIPATES IN ANY OF THE ACTIVITIES.

  2. References to “My Child and Ward”. All references in this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement to “my child or ward” shall to refer to each and every child or ward listed below.

  3. Complete Agreement. This Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement (together with the separate registration form completed and submitted to CASATELIER) is the entire agreement and understanding of the RELEASING PARTIES and the RELEASED PARTIES with respect to the subject matter hereof and supersedes all prior agreements and understandings regarding the subject matter hereof which are merged herein.

Back to contents ↑

Would you like a copy for your records?

Download Waiver Form