Name of Participant (or parent/guardian if under 18 years old) *

First Name

Last Name

Name of Child Participant (if applicable)

First Name

Last Name

Phone *

(###)

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Please read the following statements and confirm you understand our Terms of Service: *

1. I am responsible for myself/my child at all times and must act in a way that is polite and inclusive. 2. I/my child am responsible for any personal belongings. 3. Videos and photos may be taken during the classes. These may be used for social media, marketing and other platforms at the discretion of 1hundred mph. I understand that I have the right at any point to request not to be included in any footage and can do so by emailing, providing a signed letter or verbally (preferably before class) on the day. 4. I consent to 1hundred mph emailing me with information or marketing regarding their services. I have the right at any point to request this to cease and can do so by emailing or providing a signed letter.

I have read and agree to the above terms.