StudioKatieG

Consent / Waiver

Please carefully read, review, sign and submit the Client Consent & Waiver Form
before scheduling your first movement session.

NOTICE OF INFORMED CONSENT & RELEASE OF LIABILITY
for Movement and Exercise Training

I understand and acknowledge that the movement instruction I receive is provided for the purpose of exercise instruction and guidance. I further understand that Katharine Getchell, as a Natural Movement trainer and Restorative Exercise instructor, is not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, nor to provide nutritional planning, and that nothing said in the course of the session(s) given should be construed as such.

I understand and acknowledge that I should consult a physician, and/or other qualified medical specialist for any concerns, mental or physical ailment that I am aware of. I understand and acknowledge that I should seek the advice of my physician before undertaking any exercise program. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep Katharine Getchell updated as to any changes in my medical profile, and understand that there shall not be liability on Katharine Getchell's part should I forget /fail to do so.

I understand and acknowledge that I have enrolled in movement sessions with Katharine Getchell, Certified Level 1 MovNat Trainer, Certified Practitioner of Structural Integration, movement educator and coach. I recognize that the program may involve physical activity including, but not limited to, gentle stretching, muscle strength training, balance training and other various physical activities.

I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise/movement program. I acknowledge that my enrollment and subsequent participation in purely voluntary.

In consideration of my participation in this program, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors as follows: I waive, release and discharge from any and all liability for my disability, personal injury or actions of any kind which may hereafter accrue to me from this class,  Katharine Getchell (doing business as StudioKatie G). I waive, release and discharge Katharine Getchell from any claims, demands, and causes of action as a result of my voluntary participation and enrollment of the provided services and movement classes.

I fully understand and acknowledge that I may injure myself as a result of my participation in movement sessions, and I hereby release Katharine Getchell from any liability now or in the future for conditions that may obtain. These conditions may include, but are not limited to, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, other injuries to the musculo-skeletal system, shortness of breath, heart attacks, any other illness or soreness that I may incur.

I hereby affirm that I have read, understand and agree to the above.

Name *
Name
Date *
Date