spre LIABILITY waiver
Studio Evolve spre session
liability waiver form
Studio Evolve - Waiver and Release of Liability Relating to Coronavirus/COVID-19
The disease caused by the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and spreads mainly from person-to-person contact and respiration of airborne virus. As a result, federal, state, and local governments and their health agencies recommend frequent hand washing and social distancing and have, in many locations, prohibited the congregation of groups of people.
Studio Evolve has put in place preventative measures to reduce the spread of the virus; however, Studio Evolve and its employees cannot guarantee you will not become infected and develop COVID-19 when accessing or using its facilities, and participation in activities at Studio Evolve may increase your risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of the novel coronavirus and I voluntarily assume the risk that I may be exposed to the virus and may develop COVID-19 by attending Studio Evolve and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death (“Claims”).
I understand that the risk of becoming exposed to or infected by COVID-19 at Studio Evolve may result from the actions, omissions, or negligence of myself and others, including, but not limited to Studio Evolve employees, clients and class participants. I hereby voluntarily assume all of the foregoing risks and accept sole responsibility for any exposure to the novel coronavirus and/or development of COVID-19 in connection with my attendance and participation in classes and private sessions at Studio Evolve.
I hereby release, covenant not to sue, discharge, and hold harmless Studio Evolve, its employees, agents and representatives, from any and all Claims, including actions, causes of action, damages, costs or expenses arising out of or relating thereto, and all such claims are hereby voluntarily waived. I understand and agree that this release includes any Claims based on the acts, omissions, or negligence of Studio Evolve, its employees, agents, and representatives, whether a novel corona virus infection causing COVID-19 occurs before, during, or after participation in any Studio Evolve program.
I further agree to undergo non-invasive screening at Studio Evolve’s request before engaging in any activity at Studio Evolve, and that I may be denied entry to the studio facilities based on the screening. The screening may include taking my temperature, asking if I have been in close contact with a person who has been confirmed as having COVID-19, and whether I have any of the symptoms associated with COVID-19, including: cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, new loss of taste or smell.
This is not a list of all possible symptoms, if I do not feel well I agree not to participate in activities at Studio Evolve.
If I am diagnosed with COVID-19, I agree to inform my healthcare provider(s) that I participated in activities at Studio Evolve, such that appropriate contract tracing can occur. I understand that Studio Evolve requests that I notify them directly if I am diagnosed with COVID-19 and I understand that nothing in this Waiver and Release prevents me from doing so.
I have read Studio Evolve’s COVID-19 Policies and understand they are for my protection and the protection of instructors, clients and other visitors to the studio. I will adhere to the COVID-19 Policies to the best of my ability.
By checking the box below, you are agreeing to the terms of this release of liability form.
Studio Evolve General Waiver and Release of Liability
I hereby voluntarily request to receive services from Martine Dedek McNeill or Kimmie Halwachs, SPRe® Practitioners. I consent and understand that these services may include physical touch. I acknowledge that no guarantees have been made to me as to the effect of such care.
I further acknowledge that the above service is not meant to be construed by me as the diagnosis or treatment of disease, but rather as an aid to balancing my general wellness. Therefore, in consideration for my participation in SPRe®, I personally and on behalf of anyone competent to make claims on my behalf, waive any and all claims and assume all risk of loss, damage or injury associated with or incurred during my participation with my SPRe® Practitioner.
I recognize that I am responsible for my health and well-being, and that it is my duty to myself to be an informed partner in the care I receive. To this end, I will secure the self-knowledge that I need in order to fully work with my SPRe® Practitioner.
I confirm that my physical condition allows me to participate in SPRe®, if I have any question about my physical condition in this regard, I will seek a physician’s advice.
Regarding remote sessions specifically: By clicking on the link included in your email or accepting the phone call from your SPRe® Practitioner, you agree that you are aware that you are engaging in a somatic and physical activity. We will be using verbal attunement and other SPRe® skills to help support your own effective action. You are responsible for your own body and what you decide to do. You release SPRe®, Studio Evolve, Inc. for any responsibility if you injure yourself while participating in these livestream sessions. You agree that you are participating voluntarily in these sessions and assume all risk for participation. Please provide us with the address of the physical location where you will be taking the call and the name and number of an emergency contact, in case of an emergency.
Additional COVID-19 Considerations:
• Masks are recommended, but not required when inside Studio Evolve.
• Please cancel your appointment and stay home if you feel any symptoms of COVID-19 as listed by the CDC: fever or chills, cough, shortness of breath/difficulty in breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea. Your Practitioner will follow the same guidelines regarding symptoms.
I have read and understand the foregoing and voluntarily sign this Waver and Release Form.
Payment & Cancellation Policy
I understand that payment by cash, check or cc is due at the time of service. I understand that 24 hours notice of cancellation is required. There is no charge for cancellations received with more than 24 hour notice. For cancellations without notice or with less than 24 hours notice, a full session fee is charged.