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Group Training Schedule
Using the Space
Plans & Pricing
Liability Waiver & Media Release
Date of Birth
Do you have a doctor’s permit to participate in intense physical activities?
Please specify anything we should know about in regards to your physical health/past injuries.
Emergency Contact Name
Emergency Contact Relationship to You
Emergency Contact Phone
Emergency Contact Email Address
Media Release. I understand that photo and video might be taken during Human Movement Lab Programming, as a way to advertise the business. I understand that if I do NOT want my likeness on any public images, I should request that via email.
I declare that the info I’ve provided is accurate & complete
I hereby release Human Movement Lab/Kim Holman from any liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
I have read the HML Policies on the website:
If signing for a minor, minor's name
Thanks for submitting!
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