Liability Waiver

First name

Last name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Initials

I declare that the info I’ve provided is accurate & complete

To my best knowledge, I certify that I do not suffer from any condition, impairment, or disease that will preclude me from engaging in exercises. I understand that it is my responsibility to consult my physician regarding my health. I agree that I will discuss any suggested physical exercise or activity recommended by the provider before beginning. I agree that if, pursuant to this agreement, I engage in any physical exercise or activity, including virtual exercise consultation, personal exercise training, use any equipment for any purpose, I do so at my own risk and assume the risk of any and all injury and/or damage I may suffer, whether while engaging in physical exercise or not. My assumption of risk include, but is not limited to, my use of any exercise equipment (mechanical or otherwise). I assume the risk of my participation in any instruction including but not limited to dynamic moves, resistance training (body weight, resistance bands or weightlifting), stretching, and aerobic activities. I agree on behalf of myself to release and discharge the Provider from any and all claims or causes of action (known or unknown) arising out of the negligence of the provider, whether active or passive. I expressly agree that the foregoing release, waiver, and assumption of risk is intended to be as broad and inclusive as permitted by the law in the State of Massachusetts and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I acknowledge that I have carefully read this waiver and release and fully understand that it is a release of liability, and express assumption of risk. I am aware and agree that by executing this waiver and release, I am giving up my right to bring a legal action or assert a claim against the Provider for her gross negligence, or for any defective product used while receiving exercise training consultation from the Provider. I have read and voluntarily signed the waiver and release and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.

By my signature, I acknowledge that I have read, understand, and agree to the following: Payment is accepted 24 hours prior to the time of service. Cancellation Policy: 24-hour notice is required to cancel or reschedule appointments. We realize that emergencies and other scheduling conflicts arise and are sometimes unavoidable. However, advance notice allows us to fulfill other patient’s scheduling needs and keeps the online service operating at is most efficient level. Sessions cancelled less than 24 hours in advance, or No Show will be charged in full to the patient. Late to an appointment: We will start whenever you join the call within the appointment time frame. No Refund for late appointment. To respect the next patient, your appointment ending time will not change, unless schedule allows flexibility.

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Liability Waiver