Release of Liability for Melt Method Instruction
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Full Name *
Address *
Email Address
Phone Number *
Please list any health related conditions that you have or have had that could affect your ability to participate in class, including but not limited to surgeries, joint replacements, fusions, joint pain, auto-immune disorders, cancer, pregnancy, muscle, tendon or bone injury, and any chronic pain. *
Type initials after the following statements:
I am aware of my own health and physical condition. *
I acknowledge that my participation in MELT is a potentially hazardous activity. I have been informed of and understand and am aware that any exercise and/or fitness activities involve a risk of injury, and that I am voluntarily participation in these activities with understanding and appreciation of the risks involved. I hearby agree to expressly assume and accept any and all risks of injury regardless of severity. *
I understand that all information and services provided by Rita Sandquist Massage Therapy are of a general nature and are provided for educational purposes only. None of the information or services provided by Rita Sandquist Massage Therapy are to be taken as medical or other health advice pertaining to any specific health or medical condition that I have or may have had. The information and services provided by Rita Sandquist Massage Therapy are not a diagnosis, treatment plan or recommendation fro a particular course of action regarding my health and are not intended to provide specific medical advice. *
I understand that I am learning MELT techniques for my own self care and I can not teach any MELT techniques to any other group or population in a class setting until appropriately trained and licensed by Longevity Fitness. I understand that there are potential legal consequences for teaching this material directly or by teaching the techniques and calling it by another name. *
General Photography Release
I hereby authorize Rita Sandquist Massage Therapy to publish photographs taken of me at any MELT class or workshop, and my likeness, for use in Rita Sandquist Massage Therapy or MELT's print and online marketing materials.
I hereby release and hold harmless Rita Sandquist Massage Therapy from any reasonable expectation of privacy or confidentiality associated with the images specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type for these photographs.
Signature (type full name) *
Date *
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