Practice Lab Emergency Contact Form

First name

Last name

Email

City, State, Country from where you typically participate in Practice Lab

Emergency Contact Name

Emergency Contact Phone Number

Relationship to You

I understand that Practice Lab sessions involve physical movement and that I am responsible for monitoring my own safety and physical limits.

I agree to ensure I have a safe practice space free of hazards.

I understand that Midlife Shuffle Practice Lab is not medical or physical therapy instruction.

I consent to Midlife Shuffle contacting my emergency contact only in the event of a serious safety concern observed during a live session.