Balanced Body Massage will take all precautions in ensure the safety and well-being of the client during Massage Therapy and/or Fitness and Wellness Sessions under the NYS Protocol and the National Exercise and Sports Trainers Association. We recommend you receive Medical Clearance for your safety.
Medical Consent:
The client states they are fit for an Exercise Program/ Massage Therapy Treatment and has received Medical Clearance for Fitness Training and/or 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 to assessments, program design, and/ or treatments by the Therapist/ Trainer. The Therapist/ Trainer recommends Medical Clearance by a Physician before starting Therapy and/or Fitness Sessions.
Acknowledgment Waiver :
The client is hereby requesting a Consultation and/or Services with Balanced Body Fitness and Wellness LLC, Pilates Fitness & Wellness, Balanced Body Massages, and /or Myokinesis Therapy and Daniel Thomas for the sole purpose of potentially retaining a Therapist or Personal Fitness Trainer and for no other reason. I acknowledge that I am not an agent or employee of any local, state, or federal government authority; or if I am employed as an agent or employer of any local, state, or federal government authority that I am seeking this consultation in my capacity and not the capacity as government agent or employee. If consultation is on behalf of a business entity and not an individual I further represent that I am either a principal, managing agent, or partner, or if a partner, or an agent, I am authorized to execute authorization and waiver on behalf of my principle.
I acknowledge that permission for me to enter the premises or any premises related to the ownership or business of Balanced Body Fitness and Wellness LLC, and/or to receive consultation and/ or services is based on the above acknowledgment, and any misrepresentation made herein 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 defenses I may have against me for entrapment, Trespassing with Malicious intent, Trespassing, Trespassing to Chattel, harassment, fraud in the 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.
I am aware that signing this document under pretenses is a crime punishable under the laws of New York State.
I have read this document, understand its contents, and sign this waiver of my own will.
Safety Protocol and Waiver:
I read and understood Balanced Body Fitness and Wellness Safety Protocol and Policies as noted in detail on our Safety Protocol Web Page.
Your safety is our priority and we strongly recommend medical clearance from a Medical Doctor before using our services. If you feel medical clearance is unnecessary and decide to go forward with our services, you must follow our strict safety protocols. You also understand and acknowledge that our protocols are designed to minimize risk of injury.