Participant Waiver Form
The Terra Class LLC – Participant Waiver and Release Form
Participant Name: ________________________________________________________
Date: ________________________
Event/Class Title: ____________________________________________________
Acknowledgment and Assumption of Risk
I understand that movement-based, wellness, and educational classes — including those offered by The Terra Class LLC — may involve physical activity such as stretching, balance work, strength-based movement, breathwork, and mindful movement practices.
I acknowledge that participation carries certain inherent risks, including but not limited to muscle strain, soreness, fatigue, falls, or other physical discomforts.
I voluntarily choose to participate in this class or event and assume full responsibility for any risk of injury, illness, or property loss that may occur as a result of my participation.
No Medical or Therapeutic Relationship
I understand that the classes, workshops, and educational materials offered by The Terra Class LLC are provided for general wellness and educational purposes only.
These offerings do not constitute physical therapy services, medical treatment, diagnosis, or individualized healthcare advice.
Participation in this class or event does not create a physical therapy, patient–provider, therapist–client, or healthcare relationship between myself and The Terra Class LLC or any of its instructors.
If I have any health concerns, medical conditions, injuries, or if I am pregnant or postpartum, I agree to consult my physician, midwife, or qualified healthcare provider before participating.
Baby/Child Presence (Optional)
Baby/Child Presence: If you choose to have a baby or child present during participation, you acknowledge that the baby/child is not a participant, and you assume full responsibility for the baby/child’s supervision and safety at all times. The Terra Class LLC is not responsible for any injury or harm to a baby/child present during participation. The Terra Class LLC may offer optional suggestions for incorporating a baby/child into certain movements (for example, holding a baby during a functional squat), but doing so is not required and is always the participant’s choice and responsibility. You are solely responsible for deciding whether it is appropriate to hold or incorporate a baby/child during movement and for maintaining a safe environment. If you choose to hold a baby/child during movement, move slowly and stay stable; avoid balance-challenging movements and discontinue immediately if you feel unstable or if the baby/child shows distress.
Release of Liability
In consideration for being permitted to participate, I hereby release, waive, and discharge The Terra Class LLC, its owners, instructors, contractors, affiliates, partners, heirs, executors, administrators, and assigns from any and all claims, demands, damages, losses, or liabilities arising out of or related to my participation in this class or event. This release applies to any injury, loss, or damage that may occur during or as a result of participation, whether caused by negligence or otherwise, to the fullest extent permitted by law.Indemnification: I agree to indemnify, defend, and hold harmless The Terra Class LLC, its owners, instructors, contractors, affiliates, and partners from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees, brought as a result of my involvement in the class or event.
Media and Photography Consent (Optional)
Please check one:
■ I give permission for photographs or short video clips taken during this event to be used by The Terra Class LLC for educational, promotional, or marketing purposes (including social media, website, or newsletters).
■ I do not consent to the use of my image or likeness in photos or videos.
Emergency Contact Information
Name: ______________________________________________________
Phone: ______________________________________________________
Severability: If any provision of this Agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Massachusetts, without regard to its conflict of laws principles.
Binding Effect: This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, executors, administrators, legal representatives, successors, and assigns.
Signature
By signing below, I confirm that I have read and fully understand this Participant Waiver and Release Form, that I have had the opportunity to ask questions about its contents, and that I am signing it freely and voluntarily. I acknowledge that I am participating voluntarily and at my own risk. I further confirm that I am at least 18 years of age, or if under 18, that I have obtained the consent of my parent or legal guardian to participate.
Signature: ____________________________________________________
Date:________________________
Participation in The Terra Class LLC workshops and events is voluntary and educational in nature. By registering, you agree to our Refund, Community, and Accessibility Policies and understand this does not constitute individualized physical therapy or medical care.
The Terra Class LLC
Boston, Massachusetts