Liability Waiver
Current Progress
Current Progress
Current Progress
Purchase program
Confirmation
Sign waiver
Current Progress
Which one do you most identify with?
Mother
Parent
Birthgiver
Caregiver
Other
I am pregnant.
Yes
No
If yes, number of weeks:
I have been cleared for exercise by my doctor.
Yes
No
I have the following concerns or complications (check all that apply):
Diastasis Recti
Pelvic Floor
Prolapse
Mother's Thumb
Balance Issues
No Injuries
Other
If other, please provide a brief description:
LIABILITY WAIVER I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may injurious to my health, am voluntarily participating in a physical activity. Having such knowledge, I hereby release WORKOUT WITH JESS INC and any of its representatives and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity program. I hereby assume all risks connected therewith and consent to participate in said program. I agree to disclose any physical limitations, disabilities, or impairments which may affect my ability to participate in said fitness program prior to the commencement thereof. Your signature*
Today's date (ie. January 1, 2021):
MM-JS
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