The Vine Studio

Student Liability Waiver

The Vine Studio Student Liability Waiver

Please be aware of your body during class. Let us know what medical problems you may have, including but not limited to heart trouble, diabetes, hypoglycemia, asthma, lower back pain, high or low blood pressures. If you have had recent surgery, or are pregnant, you should not participate without a written consent from your doctor.


By submitting this waiver, I acknowledge that I should inform each instructor of any physical limitations, problems or conditions that would adversely affect my ability to participate in any strenuous exercise without further injury. I will abide by my instructor’s decision regarding my participation. I agree to inform the instructor of any injury or unusual pain suffered by me during the class. I understand that in any program of strenuous exercise, there is some risk of injury, despite the best efforts of the instructors and I am willing to assume all risks.


By submitting this form, I hereby release (for myself, my heirs, my executors and administrators) Nia Technique Inc., Nia Instructors, other class instructors, The Vine Studio Board and The Vine United Methodist Church from all claims, liabilities, expenses or judgments arising out of my participation in classes or workshops.  I have carefully read and understand the foregoing provisions. By signing below, I hereby certify and acknowledge that I understand all the terms of this contract and agree to be legally bound by the terms and conditions.

Call:  704-858-0379


2101 Belvedere Avenue, Charlotte, NC  28205

Room 302 of Education Building at The Vine United Methodist Church

nia-mark-2000px (2017_06_16 21_31_00 UTC
  • Facebook Social Icon