Name *

First Name

Last Name

Phone *

(###)

###

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Which Dates Would You Like to Attend? *

Once you fill out this form, you will receive an email with info on how to pay for the session(s) PayPal invoice or Venmo and then you will receive a zoom link for class!

October 3

October 10

October 17

October 24

Release & Waiver of Liability *

The participant is aware that practicing Pilates exercise and movement during Art & Core may result in accident or injury, and understands, acknowledges and assumes the risks associated with the exercises. The Participant declares their own good health and suffers from no known physical impairment which would limit their work with Elana. Participant acknowledges that Elana Jacobs has not and will not render any medical services, including medical diagnosis of Participant’s physical condition. Participant specifically agrees that Elana Jacobs shall not be liable for any claim, demand, cause of action of any kind whatsoever for, or on account of death, physical injury, property damage, or loss of any kind, resulting from or related to Participant’s use of the exercises or participation in any exercise or activity within or without the sessions, and Participant agrees to hold Elana Jacobs harmless from same. By checking the box below, I am confirming that I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

I agree