VI MOVEMENT LAB

INFORMED CONSENT AND RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in VI Movement Lab activities, programs, and related events, the undersigned acknowledges, appreciates and agrees that: 

1. The risk of injury from activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist: and,
2. I knowingly and freely assume all such risks, both known and unknown, even if                arising from the negligence of the releases or others, and assume full      responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions form participation; and, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately: and,
4. I declare myself to be physically sound and suffering from no condition, impairment, disease or other illness that would prevent my participation in and of the activities and programs or use of equipment or machinery except as hereinafter stated.  I do hereby acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical action concerning these fitness activities and equipment use. I acknowledge that I have permission to participate, or that I have decided to participate in these activities without the approval of my physician and do hereby assume all responsibility for my participation and activities.
5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless VI Movement Lab, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable owners and lessors of premises used to conduct the event (“Releasees”), with respect to all and any injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by law.
6. Explanation of the session-The exercise session you will become involved in will follow progressive exercise levels and will be regulated by your instructor. The exercise activities are designed to place a gradual workload on the body and thereby improve its functioning although no guarantee of improvement can be made. 
7. Confidentiality-The information based on the observations made during the exercise session is treated as privileged and confidential. However, it may be used for statistical or scientific purposes with your right to privacy retained. 
8. STUDIO POLICIES: All sessions expire within two months of the date of purchase. Sessions are non-transferable and non-refundable. VI Movement Lab enforces a strict 24-hour cancellation policy. Please ensure cell phones are turned off or on silent mode while in session. 

I HAVE READ THIS RELEASE OF LIABILITY, INFORMED CONSENT, AND ASSUMPTION OF RISK AGREEMENT,  FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

________________________         _________ _______________________     ________

  Participant’s Signature                         Date   Contractor’s Signature                 Date

FOR PARENTS OF PARTICIPANTS OF MINORITY AGE

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law.

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  Parent/Guardian’s Signature Date

Emergency Phone:______________________________