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2. Thank you for your interest in private exercise classes at The Lodge Des Peres. Please complete the following form and our Fitness Specialist will be in touch with you as soon as possible. Thank you!
4. Main Contact First Name:*
5. Main Contact Last Name:*
7. Address:*
9. City:*
10. State:*
11. Zip:*
13. Daytime Phone Number:*
14. Cell Number*
16. Email Address:*
18. Please select a private Zumba Party rate that applies to the main contact (all sessions are sixty minutes long with a maximum of 25 participants):

    1. Member Rate: $125
    2. Resident Rate: $125
    3. Non-Resident Rate: $150
20. Please select a private Yoga package (all sessions are sixty minutes long with a maximum of 6 participants; rates are per person):

    1. 60-Minute Private Session - 1 Person (Member/Resident) - $60
    2. 60-Minute Private Session - 1 Person (Non-Resident) - $70
    3. 60-Minute Semi-Private Session - 2 to 6 People (Member/Resident) - $35 per person
    4. 60-Minute Semi-Private Session - 2 to 6 People (Non-Resident) - $45 per person
22. Please select a private Pilates package (all sessions are sixty minutes long with a maximum of 6 participants; rates are per person):

    1. 60-Minute Private Session - 1 Person (Member/Resident) - $60
    2. 60-Minute Private Session - 1 Person (Non-Resident) - $70
    3. 60-Minute Semi-Private Session - 2 to 6 People (Member/Resident) - $35 per person
    4. 60-Minute Semi-Private Session - 2 to 6 People (Non-Resident) - $45 per person
24. Please list all requested dates and times for your private exercise session (please be as specific as possible):
26. Please list any goals, comments or special requests:
28. Private exercise sessions will not be scheduled without full payment of package. The Fitness Specialist will be in touch with you to set up your private exercise session and take payment. Please allow 7-10 business days for completion of paperwork and for arrangement of sessions. Thank you for choosing The Lodge Des Peres
30. Private Exercise Session Policies and Waiver*
    By initialing, I acknowledge that I have read and understand the Private Exercise Session Policies: 1)Private sessions cancelled due to weather will be made up at a time convenient for both instructor and student; 2) Private sessions cancelled less than 24 hours in advance of lesson will be forfeited. Cancellations made more than 24 hours in advance will be rescheduled. 3) Private session packages expire 1 year from date of purchase. If accommodations due to a disability are needed to participate please call Terri Johnson, Inclusion Coordinator, at 314-835-6157. In case of inclement weather, please call 314-835-6138 for program cancellation information. By initialing, I also agree to the City of Des Peres waiver of release and liability below.
    WAIVER OF RELEASE AND LIABILITY
    The Des Peres Parks and Recreation Department is not responsible for any injury or loss of property suffered while participating in Des Peres Parks and Recreation activities, using equipment, or on any Des Peres Parks and Recreation premises, for any reason whatsoever, including ordinary negligence on the part of Des Peres Parks and Recreation, its employees, instructors, or agents, from any and all present and future claims resulting from participation in activities both present and future, that may be made by the registrant, the registrant's family, estate, heirs, or assigns. By participating, you agree to having your picture or likeness represented and published in any City of Des Peres publication or media. By participating, you represent that you are in good health. You are aware that health, fitness and recreation activities may range from vigorous cardiovascular activity to the exertion of strength training; and that these, and other activities provided by Des Peres Parks and Recreation involve certain risks, including but not limited to death, disability, serious neck and spinal injuries resulting in complete paralysis, heart attack, and injury to bones, joints or muscles. By participating, you and your family are agreeing to voluntarily participate in activities with full knowledge of the inherent risks of property damage, personal injury, or death. You understand that Des Peres Parks and Recreation encourages you to consult a physician before beginning any exercise or recreation program. You understand and agree to this waiver to be as broad and inclusive as the laws of the State of Missouri will permit and affirm that you freely agree to the rules and regulations of the Des Peres Parks and Recreation Department.
    PRIVATE ZUMBA PARTY POLICIES
    •The use of the facilities shall not include business, commercial, or fundraising activities without prior approval of the Director of Parks and Recreation. •Renter will be responsible to immediately pay the City of Des Peres for any and all damages to the facility and/or extraordinary cleaning resulting from usage. Damage and/or cleaning fees will be charged to the credit card supplied by the renter for the security deposit. • The reservation time period must include all preparation, clean up and restoration. Any extension of the reservation time period will result in applicable charges. • Renter agrees to remove all belongings and place all trash in the proper receptacles by the end of the rental. Renter agrees to place all towels in the proper receptacles by the end of the rental. • There will be no food, beverages or alcohol served or brought into the Group Exercise Studio. • Decorations may not be used in the Group Exercise Studio. Nothing may be attached to walls, ceilings, windows, cabinetry, light fixtures, or the sprinkler system. Confetti is not allowed. • The Lodge provides the event space, Zumba instructor and sound system. The Lodge does not supply any other equipment. • The Zumba instructor will be employed and scheduled by The Lodge. Outside instructors or fitness professionals are not permitted to conduct business on City property. • A minimum of one (1) adult supervisor per 10 children under the age of 17 is required. The ratio of one adult per 10 children applies in all areas of the facility, including the Group Exercise Studio. Facility staff is not available for group supervision. • There is a maximum capacity of 25 people for a Zumba Party in the Group Exercise Studio. • Use will be restricted to the terms of the application, including area reserved, time of the rental and intended activity. • Renter agrees to take all reasonable steps necessary to assure all local, state and federal laws and Lodge regulations are complied with, including but not limited to, prohibiting any person under the age of 21 from consuming alcoholic beverages on The Lodge premises. Violations of any such guidelines or misrepresentation of use may be cause for immediate cancellation of the rental. • The Lodge reserves the right to refuse admittance to any person or persons, or to eject any person or persons who may cause or may reasonably be expected to cause harm or damage to any person or thing. • Facilities are available to people of all abilities. Renter may not exclude anyone from participation or subject anyone to discrimination based on race, religion, color, national origin or disability. • Rental of one room does not automatically authorize use of other parts of the facility. • Applicant renting the facility must be 21 years or older, and must be present during the entire rental period. • Rentals must not infringe on or restrict the use of the facility by other groups or programs. • Any accidents occurring on the property must be immediately reported to the Supervisor on Duty. • The use of any tobacco product or illegal substance in the facility is strictly prohibited. • The City of Des Peres will not be responsible for any personal property. • All rentals must follow the general facility rules, including but not limited to those enforced in the aquatic and fitness centers. • Renter agrees to hold harmless the City of Des Peres, its officials, and employees from any claim or course of action brought by the renter, his agents, employees or guests arising from the use of the facility.
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