Hip Pain & The Pelvic Floor: The Missing Link for Runners - Registration form
Complete this form to sign up for the  Hip Pain & The Pelvic Floor: The Missing Link for Runners

Date: Saturday, 12/6/25
Time: 11:00am-12:30pm
Location: Empire Athletics, 507R Lancaster St, Leominster, MA
Cost: Free

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First Name *
Last Name *
Email Address *
Phone number *
How long have you been in pain? *
What have you tried to feel better? *
Why is it important for you to get out of pain? *
Waiver of Liability Agreement

PLEASE READ THE FOLLOWING:

During the Hip Pain & The Pelvic Floor: The Missing Link for Runners workshop, we may provide a few simple exercises to work on at home that may be beneficial for your pelvic health and general fitness. 

The purpose of this event is not to diagnose, or treat an injury, illness, or condition. While the workshop is instructed by trained individuals, risk of injury is still present with participating. The risk of injury cannot be eliminated, regardless of the care taken to avoid such injuries and the undersigned individual shall assume all risk by participating in the workshop. 

By electronically signing, I do waive and forever release any and all rights and claims for any damages and liabilities of any kind arising out of my participation in this event, against all persons, entities, and agencies involved with performing the workshops, including but not limited to: Kevon Plouffe, Empire Athletics, Autonomy Pelvic Health, LLC, and any other related individuals or entities. 

I understand that this workshop is not intended to diagnose, or treat any injuries, illness, or conditions, but to assist with educating me on optimizing my pelvic health and general fitness. I also understand that my participation in this screen is optional, and is not a guarantee of optimizing my pelvic health. The results will not be shared with any individuals or entities except as outlined herein and will only be used for informational purposes, including tracking of injuries and/or trends. 

I also agree to being contacted by Autonomy Pelvic Health, LLC and Kevon Plouffe in the future. We will not share your personal information. I have carefully read this waiver of liability and understand that I am giving up legal rights, including my right to sue. I acknowledge that I am signing this waiver freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the extent allowed by law. Autonomy Pelvic Health and Kevon Plouffe are committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you.

You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy.

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