Client Waiver

                            Today's Date:                  //

Address:                       Apt. #    DOB:                  //

City:                                State:                    Zip Code:                   

Daytime Phone:                              Evening Phone:                   

Email Address:                                 Age:                      Male    Female 

Emergency Contact:                       Phone:                 

Dr. Name:                        Phone:     

Liability for personal property:  I acknowledge and agree that MBS Proactive Health and Wellness, LLC, any of its subsidiaries or other affiliates and any of its respective officers, directors, employees, and agents successors shall not be liable to me for any personal property that is damaged or stolen while on or around any training premises including, but not limited to; a vehicle or its contents or any property left in the lockers.

Agree
 

Agree

Health representation and agreement:  I represent and warrant to MBS Proactive Health and Wellness, LLC, that I am in good physical condition and have no medical reason or impairment that could prevent me from my intended use of Mind Body Soul services.

Agree
 


Agree

 

Waiver of liability; Assumption of risk:  I acknowledge that the use of MBS Proactive Health and Wellness, LLC, facilities, equipment, services, and programs involves an inherent risk of personal injury and I voluntarily agree to assume all risks of personal injury and I waive any and all claims or actions that I may have against MBS Proactive Health and Wellness, LLC, any of its subsidiaries or other affiliates and any of its respective officers, directors, employees, agents, successors and assigns for any such personal injury (and no such person shall be liable to me for any such personal injury) including, without limitation (I) injuries arising from use of any exercise equipment and machines.  (II) Injuries arising from participation in supervised or unsupervised activities and programs in exercise rooms.  (III) Injuries or medical disorders resulting from exercising at any training facility, including heart attacks, strokes, heat stress, sprains, broken bones, torn or damaged muscles, ligaments or tendons, and (IV) Accidental injuries within any facility, including dressing and locker rooms.  I acknowledge that MBS Proactive Health and Wellness, LLC, does not manufacture any of the fitness or other equipment at its facilities and Mind Body Soul does not manufacture any vitamins, food products, sports drinks, nutritional supplements and other products sold through its website; accordingly, neither MBS Proactive Health and Wellness, LLC, any of its subsidiaries or other affiliates and any of its respective officers, directors, employees, agents, successors or assigns shall be held liable for any such defective equipment or products.  I will indemnify MBS Proactive Health and Wellness, LLC, any of its subsidiaries or other affiliates and any of its respective officers, directors, employees, agents, successors and assigns (an “indemnified party”) and save and hold each of them harmless against and pay on behalf of or reimburse any such indemnified party as when incurred for any losses which such indemnified party may suffer, sustain or become subject to, as a result of, in connection with, relating or incidental to or by virtue of any claim that is the subject of the waiver set forth above.

It is my choice to receive Personal Training instruction.  I am aware of the benefits and risks of training and give my consent for said activities.  I understand that there is no implied or stated guarantee of success or effectiveness of individual techniques or series of appointments.  I acknowledge that Personal Training is not a substitute for medical care, medical examination, or diagnosis.  I have stated all medical conditions that I am aware of and will inform my Personal Trainer of any changes in my health status.

Agree
 

Agree

Cancellation Policy:  I acknowledge that, once purchased, all sessions are non-refundable, and will expire 6 months from the date of purchase.  I understand that all sessions are scheduled in advance, and require a 24-hour cancellation notice to prevent from being charge for said session resulting in a “no show."

Agree
 

Agree

I agree
By clicking the submit button, you hereby agree to all terms of this client waiver.