WAIVER OF LEGAL LIABILITY.
RELEASE OF LIABILITY FOR RECEIPT OF NUTRITION INFORMATION AND WAIVER OF CLAIMS ARISING FROM RECEIPT OF NUTRITION INFORMATION
The nutrition information provided by “Nutritionist” is designed for and solely intended to be suggestions which may voluntary be implemented into the diet of the person whose signature appears below “the client”. Use of any nutrition information provided by the Nutritionist is completely voluntary and each User is solely responsible for their voluntary choice to implement the dietary suggestions. It is the sole responsibility of the client to provide complete and accurate information. Any misinformation or omitted information may affect the nutritional assessment or advice. Any misrepresented information is solely the client’s responsibility and (nutritionist), will not be liable. The Nutritionist provides nutrition consulting and recommendations only and is not licensed to diagnose a medical condition or illness. The client must consult a physician for any medical advice.
WAIVER AND COVENANT NOT TO SUE
I have volunteered to participate in a wellness program under the direction of the Nutritionist, which will include, but may not be limited to nutritional planning. In consideration of Nutritionist’s agreement to assist me, I do here and forever release and discharge and hereby hold harmless Nutritionist and his/her respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in any nutrition program including any injuries resulting there from.
ASSUMPTION OF RISK
Nutritionist recommends you consult your physician before undertaking any diet or exercise program.
By implementing the suggestions provided by Nutritionist, the client is affirming that she or he has consulted with a medical doctor and has been cleared to implement the suggestions.
Any nutrition information provided is not intended to diagnose, treat, cure or prevent any type of disease or condition. If you need specialized dietary planning to treat, cure, or prevent any type of disease or condition, you should consult with your medical doctor.
If I am pregnant or lactating, have high cholesterol, high blood pressure, high blood sugar, diabetes, renal disease, have had gastric bypass surgery, or currently have (or have had in the past) any other medical condition that requires special dietary restrictions, I must receive permission from my physician before participating in the wellness program, or may be advised to seek help from another health professional.
I recognize that specific foods may create allergic and possible fatal reactions. I have therefore specified any food allergies/sensitivities I am aware of on the client intake form. I am aware that specific foods may interact with certain medications. I have therefore specified all prescription and OTC medications on the client intake form, and have discussed the side effects of all of my medications with my doctor or pharmacist.
I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this wellness program. I understand that results are individual and may vary.
I HEREBY AGREE THAT;
“I, ________________, have enrolled in the personalized Strength and Conditioning program offered through Transform Athletic Center Office (TAC). I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness 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 program. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by TAC.
“In consideration of my participation in this program, I, ___________________, hereby release TAC and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment.”
“I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I, ______________________ , hereby release TAC and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death.”
I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.
Signature: ________________________________ Date: ___________________________
Email: ____________________________________ Is it ok to email You? _____________
Print name: _____________________________________________________
Mailing address: _________________________________________________
Parent/guardian signature: ________________ Parent’s/guardian’s Name: ______________
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