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waiver

By signing this form I agree not to hold Jennifer Polyocan liable for any injury or communicable disease ex. covid19 that may incur during your lesson with Jennifer. This is for online lessons and in person lessons. You will not hold her responsible and this releases her from any legal obligations.

Please fill out the following form.

Date of birth
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes

Contact

I'm always looking for new and exciting opportunities. Let's connect.

415.279.2039

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