Myokinesis Therapy Studio will take all precautions in insure the safety and well being of the client during Myokinesis/Massage Therapy Treatments and/or Fitness and Wellness Sessions in accordance to NYS Protocol and National Exercise and Sports Trainers Association. We recommend you receive Medical Clearance for your safety.
Client states they are fit for an Exercise Program/ Myokinesis/Massage Therapy Treatments and has received Medical Clearance for Fitness Taining and/or Myokinesis/Massage Therapy Sessions and /or understands the risk of injury involved with increasing physical activity and/or receiving treatments without the consent of a physician and has decided to go forward with a Fitness Program and or Massage Therapy Program. The client further understands and consents assessments, program design and/ or treatments by Therapist/ Trainer. The Therapist/ Trainer recommends Medical Clearance by a Physician before starting Therapy and/or Fitness Sessions.
Acknowledgement Waiver :
Client is hereby requesting a Consultation and/or Services with Myokinesis Therapy, Pilates Fitness and Welllness, Balanced Body Fitness and Wellness LLC and Daniel Thomas for the sole purpose of potentially retaining a Therapist ot Personal Fitness Trainer and for no other reason. I acknowledge that I am not an agent or employee of any local, state or federal goverment authority; or if I am employed as an agent or employer of any local, state or federal goverment authority that I am seeking this consultation in my individual capacity and not the capacity as goverment agent or employee. If consultation is on behalf of a business of a business entity and not an individual I further represent that i am either a principle, managing agent, partner or if a partner, or if an agent, that I am authorized to execute authorization and wavier on behalf of my principle.
I acknowledge that permission for me to receive this consultation and/ or services is based on the above acknowledgment, and any misrepresentation made herein in order to receive the consultation and/or services will be deemed entrapment and Trespassing with Malicious Intent, intentional infliction of emotional distress and all other applicable damages.
I waive any and all defenses I may have against me for entrapment, Trespassing with Malicious intent, Trespassing, Trespassing to Chattel, harassment, fraud in inducement, intentional infliction of emotional distress and any other damages incurred by Balanced Body Fitness and Wellness LLC and/or Daniel Thomas as a result of misrepresentation stated above for receiving consultation and/or services rendered to me at 27 Purick Street, Blue Point NY 11715.
I am aware that signing this document under false pretenses is a crime punishable under the laws of New York State.
I have read this document and understand its contents and sign this waiver of my own free will.