Metanoia-KC LLC Client Agreement
Assumption of Risk, Waiver & Release of Liability, & Indemnity Agreement
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Preferred Contact
Email, Phone Call, or Text
Emergency Contact Information:
Name, Relation, Phone Number
Favorite Food(s)
Favorite Music While Working Out
Immediate Family Information
Name, Relation, Age
Please fully read the following agreement before continuing. All terms must be agreed upon before beginning service(s).
*
I have fully read, understand, and agree to all terms within Metanoia-KC LLC's ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, AND INDEMNITY AGREEMENT
I have read, understand, and agree to all terms
No (please contact Metanoia ASAP)
I understand the services provided by Metanoia-KC LLC are in no way intended as medical advice or to serve as a substitute for medical and behavioral counseling. The recommendations provided should be used in conjunction with the guidance and care of your physician. Metanoia-KC LLC is not a physician, Nutritionist, or Registered Dietician, and the scope of consultation services does not include treatment or diagnosis of specific illnesses or diseases.
I understand
I understand if I need to cancel or reschedule a session, I MUST contact Metanoia-KC LLC via email (jennylynn@metanoia-kc.com) to notify 24-hours in advance. 24-hours is required for a cancellation and/or reschedule in order to receive credit for the session. Failure to cancel within this time frame or failure to show up for a session will result in being charged for the session, no exceptions.
I understand and agree
Respecting Trainer and Metanoia Client schedules is important; I understand that I will be held accountable for my scheduled session time(s). We will begin promptly at the scheduled time. Should I be late or early, I will not receive a longer session.
I understand and agree
I understand if I have a purchased a program (ex: 12-week fitness program and/or 4-week nutrition program), Metanoia-KC LLC has fully committed to my success and held a client spot for me for this time period. I must complete all sessions within the program time period, any sessions not completed will be forfeited. I understand if I purchased a set number of sessions, I have 6 months to use before expiration.
I understand and agree
I understand there is a no-refund policy on all classes, sessions, programs, and/or packages purchased. I understand service will cease and be forfeited entirely should payment (in-full and/or payment plan) not be received. I also understand I cannot transfer classes, sessions, programs, and/or packages to another party.
I understand and agree
I understand a commitment to my health and wellness will not always be fun and/or easy. When I may not be feeling it, I will dig deep to remind myself why I am on this current path and will hold myself accountable! I understand and know I am worth it!
I understand and agree
Date
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Month
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Day
Year
Date
Signature
Submit
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