Client Full Name: _________________________________________
Date of Birth: _____________________
Phone: __________________________
Email: ___________________________
I understand that the services offered by Immortal Tribe Wellness, including but not limited to yoga instruction, guided breathwork, assisted stretching, mobility training, and the use of massage tools (e.g., massage guns), are provided for the purposes of relaxation, stress reduction, mobility enhancement, and overall well-being. These services are delivered under the scope of practice of a certified yoga teacher and wellness guide and do not constitute physical therapy, chiropractic care, or licensed massage therapy.
I understand that yoga, assisted stretching, and related movement practices involve inherent risks, including but not limited to muscle soreness, joint discomfort, soft tissue injury, dizziness, and in rare cases, more serious injury. I affirm that I am in good physical condition and do not suffer from any condition that would prevent my participation.
I acknowledge that it is my responsibility to consult with a licensed physician before engaging in any new wellness program. I agree to inform the practitioner of any medical conditions, injuries, or changes to my health that may affect my participation.
I voluntarily choose to receive services from Immortal Tribe Wellness and consent to participate in all related activities. I understand that I may stop any activity at any time. I agree to communicate clearly with the practitioner if I experience pain, discomfort, or uncertainty about any technique being used.
In consideration for receiving services, I, on behalf of myself and my heirs, assigns, and legal representatives, hereby release, waive, discharge, and hold harmless Christopher Grant, Immortal Tribe Wellness, its employees, agents, contractors, and representatives from any and all claims, demands, damages, or causes of action arising from or related to any loss, injury, or accident that may occur during or as a result of participation.
I understand that the services provided are not a substitute for medical care or diagnosis. I agree to seek medical attention from a licensed healthcare provider for any physical or mental health concern.
I acknowledge the contagious nature of the coronavirus (COVID-19) and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by receiving services in-person. I agree to follow any and all health protocols requested by Immortal Tribe Wellness, including rescheduling if I experience symptoms such as fever, cough, or loss of taste/smell.
I release and hold harmless Immortal Tribe Wellness and its representatives from any and all claims related to exposure to or infection by COVID-19, to the fullest extent permitted by law.
If the client is under the age of 18, a parent or legal guardian must sign below:
I am the parent/legal guardian of the minor named above. I have read and understood this waiver, and I consent to the minor receiving services from Immortal Tribe Wellness. I agree to all terms on their behalf.
Minor’s Name: __________________________
Parent/Guardian Name: __________________________
Parent/Guardian Signature: ______________________ Date: ___________
☐ I grant permission for photographs or videos taken during sessions to be used for educational or promotional purposes by Immortal Tribe Wellness.
☐ I do NOT grant permission.
I have read this waiver in full, understand its contents, and voluntarily agree to its terms.
Client Signature: ___________________________ Date: ___________
Practitioner Signature: _______________________ Date: ___________
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