Studio Release Form

GYROTONIC® Soho - Movement Beyond

First Name: ____________________________     Last Name: ___________________________
Date of Birth: __________________   Address:  ______________________________________

City: _________________________   State: __________________   Zip: __________________    

E-Mail: ______________________________________   Phone: _________________________      

Occupation / Studies: ____________________How did you hear about us? ____________________

List your exercise history:

Have you done GYROTONIC®, and/or GYROKINESIS® Exercise, or Yoga/Dance before?     Yes_______     No_______

If yes, rate your level of experience: Beginner_____    Intermediate_____     Advanced______

What do you want to gain through GYROTONIC® training?

Do you wish to join a GYROTONIC® Tower class in the future?      Yes_______     No_______     

Previous / Current injuries or health issues:

I wish to be on the GYROTONIC® Soho - Movement Beyond mailing list to receive Newsletters and to know about promotions, events and offerings.

Yes_______     No_______

* We are committed to protecting your privacy and will never share, rent or sell your personal information to third parties.

Release Form

I recognize that GYROTONIC® Soho - Movement Beyond, Studio 580 LLC, is serving to help me learn about my body and movement. I understand that these activities may at times be strenuous and require physical activity. Through my participation I agree to take full responsibility for my physical fitness, not to exceed my limits in practicing any activities at GYROTONIC® Soho - Movement Beyond, Studio 580 LLC, and/or for any injury I might suffer during the practice or in any other treatment offered by GYROTONIC® Soho - Movement Beyond, Studio 580 LLC. It is my responsibility to ascertain that there are no medical reasons that prevent my participation. I assume full risk for any injuries that may incur and waive any claim that I might have at any time, now or in the future, for injury of any sort, against GYROTONIC® Soho - Movement Beyond, Studio 580 LLC, or any person or entities in anyway involved therewith, in regards to GYROTONIC® Soho - Movement Beyond, Studio 580 LLC.

I have carefully read the above release and fully understand and agree.

_______________________________________________________________________________

Signature                                                     Date

GYROTONIC® Soho - Movement Beyond

Studio 580 L.L.C

401 Broadway Suite 709, New York, NY 10013

646-613-8086   info@movementbeyond.com   www.movementbeyond.com