Client Intake & Liability Waiver

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Home Address (for session location)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Do you have any past or current injuries, medical conditions, or physical limitations?

Are you currently under the care of a physician or taking any relevant medications?

Emergency Contact (Name - Relation, Phone Number)

Current Activity Level

Areas of Tightness and Discomfort

Do you have any goals you wish to accomplish?

Waiver and Release of Liability

I understand that assisted stretching involves hands‑on guidance, movement of my limbs, and physical interaction intended to improve mobility, flexibility, and overall wellness. I acknowledge that assisted stretching carries inherent risks, including but not limited to muscle soreness, strain, joint discomfort, or other physical responses. I confirm that I have disclosed all relevant medical conditions, injuries, or limitations to Unique Standard Wellness and Performance and will continue to do so before each session. I understand that assisted stretching is not medical care, physical therapy, or chiropractic treatment, and I am responsible for seeking medical clearance when appropriate. By participating, I voluntarily assume all risks associated with assisted stretching, including risks inherent to the activity and risks that may arise from my own failure to disclose information.&#13;&#10;&#13;&#10;In consideration of receiving assisted stretching services, I knowingly and voluntarily release and discharge Unique Standard Wellness and Performance, Jordan Swain, and all employees, contractors, agents, and representatives (collectively, the “Released Parties”) from any and all liability, claims, demands, or causes of action arising out of or connected with my participation in assisted stretching sessions, including claims arising from the ordinary negligence of the Released Parties. I understand that this release does not apply to conduct that cannot legally be waived under applicable state law. I acknowledge that the Released Parties may maintain professional liability insurance, but I agree that this release is effective regardless of insurance coverage.&#13;&#10;&#13;&#10;I agree to indemnify and hold harmless the Released Parties from any claims, damages, or expenses, including attorney’s fees, arising from my participation in assisted stretching sessions, my failure to disclose relevant health information, or claims brought by third parties arising from my actions. This indemnification applies only to the extent permitted by applicable law and is not intended to require me to indemnify the Released Parties for their own negligence.&#13;&#10;&#13;&#10;Clients under the age of 18 must have a parent or legal guardian present at the first session and must provide written consent for ongoing services. The parent or guardian must sign this waiver and agrees to all terms on behalf of the minor.&#13;&#10;&#13;&#10;I understand that the Released Parties are not responsible for determining whether assisted stretching is medically appropriate for me and are not responsible for providing emergency medical care. If an emergency occurs, I authorize the Released Parties to seek medical assistance on my behalf if necessary, and I am responsible for any related costs.&#13;&#10;&#13;&#10;This agreement is governed by the laws of the state in which services are provided. If any provision of this agreement is found unenforceable, the remaining provisions will continue in full force and effect. By signing below, I acknowledge that I have read and fully understand this agreement, that I am voluntarily signing it, and that I am waiving certain legal rights. I confirm that I am at least 18 years old, or I am the legal guardian signing on behalf of a minor client.

Cancellation Policy

I understand that my appointment time is reserved specifically for me. Cancellations or rescheduling must be made at least 12 hours in advance. If I cancel within 12 hours of my appointment or fail to attend, I understand that the full session fee will still apply and no refund will be given unless otherwise approved.

I acknowledge that I have read and agree to the waiver, release of liability, and cancellation policy above.

Consent to Be Stretched (This Is a Hands On Process)

Signature Date

Date