Coach Emma - Small Group Fitness - Competitive Edge Physiotherapy

Name*
Name Phone
Date of Birth*
MM slash DD slash YYYY
Day Phone*
Cell Phone
Emergency Contact*
Name Phone
Email*
Address*

[Street #, Street Name, City, Postal Code]
I agree to release and waive all claims and hereby indemnify and hold harmless the Corporation of Competitive Edge Physiotherapy and Sport Conditioning (CE) and its elected officials, officers, employees, agents representatives, volunteers and other participants (“The Indemnified Persons”) for a any and all liability for any property damage or personal injury resulting to me or to any of the above-named person(s) for whom I am in law responsible, from or connected with participation in any activity contemplated by this Registration. I hereby further agree that CE and the Indemnified Persons shall not be liable, either directly or indirectly, for any claims, or damage, costs and expenses respecting any act done in good faith, including but not limited to personal injury, death, property damage or loss resulting from or connected with participation in any activity contemplated by this Registration. I have read and understood the Waiver of Liability*
- Yes
- No
Session Days
- Saturdays 12-1pm
Rate Options
- Pay per session - $30.00 plus HST ($33.90)
- 4 sessions - 100.00 plus HST ($113.00)
*Payment must be received to confirm your spot please E-Transfer to [email protected]