THE MOJO TECHNIQUE | JUNGLE RED STUDIO

Movement Participation Waiver + Health Acknowledgment

 

Student Name: 

Date: 

 

 

 

At The Mojo Technique and Jungle Red Studio, we believe movement is medicine. We also believe in personal responsibility and transparency. We are honored to hold space for healing, strength, and creativity — but we are not licensed medical providers. Please read and sign this waiver acknowledging the following:

 

 

 

    •    I understand that:

    •    • Movement classes (including pole, aerial, burlesque, yoga, and somatic work) involve physical exertion, risk of injury, dizziness, strain, and other possible side effects.

    •    • It is my responsibility to consult with a physician regarding any pre-existing conditions before participating.

    •    • If I have any physical or mental health conditions (diagnosed or undiagnosed) that could impact my safety, it is my responsibility to disclose that to my instructor and to participate at my own risk.

    •    • If I choose not to disclose health issues, I understand that The Mojo Technique and its instructors cannot be held liable for any injury or incident resulting from that nondisclosure.

    •    I agree to:

    •    • Monitor my own physical and emotional limits during class.

    •    • Modify or stop when needed.

    •    • Accept full responsibility for my own body and health during all classes, workshops, and open studio time.

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Optional (Confidential):

I’d like to share something I think my instructor should know to support my safety:

______________________________________________________________

______________________________________________________________


Emergency Contact Name & Number: ____________________________


By signing below, I acknowledge that I have read, understood, and voluntarily agree to this waiver.

Signature: _______________________________________

Date: _____________________