Name *

First Name

Last Name

Waiver of Liability *

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold harmless Lisa Thorngren dba Synapse in Motion, LLC, to the fullest extent permitted by law, from any and all claims that may arise out of my participation in dance/movement classes offered by Synapse in Motion, LLC. Furthermore, I acknowledge that with any type of physical training there is a risk of injury or death, and I acknowledge that I am assuming all responsibility for that risk by participating in any activities with Lisa Thorngren dba Synapse in Motion, LLC.

I Agree

Statement of Acknowledgement *

By selecting "I Agree" below, I am acknowledging that I have read this release of liability and assumption of risk, that I fully understand all of the terms included, that I am waiving substantial rights by signing it, and that I have signed it freely and voluntarily without any inducement.

I Agree