top of page

About
Services
On Demand Library
Book A Class
Plans & Pricing
Testimonials
Contact
News
More

Use tab to navigate through the menu items.

6B63442E-6A1B-4148-A95A-65BC5AFDE5E7.jpe

Health Declaration & Liability Waiver

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

Are you experiencing any flu symptoms?

No

Yes

Date

Initials

I confirm that the information given in this form is true and I have read and understand the Release of Liability and agree to be bound by its terms.Release of Liability.

Thanks for submitting!

© 2022 Diana Tsuruda. All Rights Reserved.

Website Design by Quill Shift LLC.

bottom of page