GROW YOUNGER FREE FITNESS BOOTCAMP

REGISTRATION FORM

WAIVER AND RELEASE OF LIABILITY FOR WELLNESS PROGRAM

I hereby agree to the following:

1. I am participating in the wellness program “Grow Younger” (hereinafter known as “the Program”), conducted by Mrs. Mala Mansukhani with my own free will. I understand perfectly well that Mrs. Mala Mansukhani is a fitness and wellness enthusiast, she is not a certified trainer or a doctor.

2. I understand that it is my responsibility to consult with a physician prior to and regarding participating in the Program. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in the Program.

3. I agree to assume full responsibility for any risks, injuries or damages, known or unknown which might incur as a result of participating in the Program.

4. I voluntarily and expressly waive any claim that may arise against Mrs. Mala Mansukhani as a result of my participation, including any injury, personal injury, damage, or illness that may result in relation to the Program.

5. I, my heirs or legal representatives forever release and hold harmless, waive, discharge and covenant not to sue Mrs. Mala Mansukhani in case of any injury, harm, damage, illness or death of participant during or in relation to the Program.

I have read the above release and waiver of liability and I fully understand its contents. I voluntarily agree to the terms and conditions stated above.