Loading...

Embodied Fitness and Somatics LLC

Embodied Fitness and Somatics LLC

Training, Movement, and Somatic Experiencing Agreement and Waiver of Liability

In consideration of the risk of injury while participating in Training, Movement, and/or Somatic Experiencing (hereafter referred to in all combination as the “Activity”), including any combination of these activities, and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representative, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims, or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Embodied Fitness and Somatics LLC (hereafter referred to as “the Company”), based out of Glendale, California, and also operating in Los Angeles, California, and online, and Emily Decker (hereafter referred to as “Coach”), their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical loss, or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity, and including any harm that may befall me as a result of using equipment that I provide or that is provided to me.

I am voluntarily participating in the aforementioned Activity, and I am participating in the Activity entirely at my own risk.

I attest that I have been cleared by a medical professional to participate in this movement program.

I understand that it is my responsibility to keep the Company and my Coach apprised of all new physical conditions that may arise during my time participating in the Activity. I understand that my Coach is not a doctor and cannot medically clear me for training, and cannot medically clear me for continued training after the onset of any new conditions. I take full responsibility for my own health in the event that I choose to continue with the movement program after the onset of any new condition.

I am aware of the risks associated with this Activity, including travel to and from this Activity and participating in this activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability including paralysis, economic or emotional loss, and death. I understand that these outcomes may arise from my own or others’ negligence, conditions related to travel, equipment (including mine, my Coach’s, or a gym’s), or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to or from this Activity by any form of transportation.

I agree to indemnify and hold harmless my Coach and the Company against any and all claims, suits, or actions of any kind whatsoever for liability, damages, compensation, or otherwise, brought by me or anyone on my behalf, including attorney’s fees, and any related costs, if litigation arises pursuant to any claims made by me or anyone else acting on my behalf.

I acknowledge that this Activity may involve a test of a person’s physical and mental limits and may carry risks included, but not limited to, those caused by terrain, equipment, facilities, temperature, weather, lack of hydration, vehicular traffic, and actions of other parties, including but not limited to participants, volunteers, spectators, staff, and coaches.

In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred.

In the event that any damage to equipment or facilities — including my own equipment or facilities, my Coach’s equipment or facilities, or any gym’s equipment or facilities — occurs as a result of my or my family’s, tenant’s, or roommate’s willful actions, neglect, or recklessness, I acknowledge and agree to be held liable for any and all costs associated for repair or replacement, as deemed appropriate by the owner of the equipment or facility.

If, due to my, my family’s, my tenant’s, or my roommate’s willful actions, recklessness, or negligence, the Coach is injured at a property I rent or own, I agree to be held financially responsible for all costs associated with the injury.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase, or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties.

 I understand that this Activity is designed to augment my wellbeing and that I have the right to terminate the relationship at any point for any reason, including a perceived lack of benefit from this service. 

I understand that the use of technology is not always secure, and I accept the risks of confidentiality in the use of email, text, phone, Zoom, FaceTime, Instagram, Notes, and other technology. I understand that my trainer may ask me to write a testimonial about this service for use in promotional materials, and that I have a right to decline to do so.

I acknowledge that I have carefully read this Waiver of Liability and fully understand that it is a release of liability. This agreement is entered into willfully by me, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength.

I Agree

I understand that any Somatic Experiencing and/or life coaching with Embodied Fitness and Somatics LLC is not a substitute for professional therapy or mental healthcare and is not intended to diagnose, treat, or cure any mental health or medical conditions, including eating disorders, body dysmorphia, post-traumatic stress disorder, depersonalization, or any other condition. I understand that Emily Decker is a Somatic Experiencing trainee and has not yet completed the Somatic Experiencing program. I understand that life coaching is an unregulated industry, and that my coach retains no applicable license in this profession. I acknowledge that I am solely responsible for my physical and psychological wellbeing, and I agree to hold Emily Decker and Embodied Fitness and Somatics LLC harmless for any psychological, emotional or physical distress, pain, injury, or damage of any kind, including, but not limited to, physical, emotional, and financial, that may arise as a result of this professional relationship. I understand the Company recommends that I speak with a licensed therapist or dietitian if I believe that service is needed.

I Agree

CANCELATION POLICY

I understand that if I do not give 24-hour notice in cancelling or rescheduling a session, I am expected to pay in full for that session. If I have paid for a 4-week membership, that credit will be deducted from my sessions. An exception is made in the first instance of a late-cancel, as long as I have canceled before the session begins.

The following applies to 4-week and 8-week packages:

I understand that four-week packages expire after five weeks and eight-week packages expire after nine weeks, counting from the day of the first session. I understand that my trainer is setting aside a specific day and time for me each week and will attempt to accommodate rescheduling needs but cannot guarantee the ability to reschedule multiple sessions within that time frame. I understand that after that time frame, unless otherwise agreed upon, my session credits will expire.

I Agree

 

 

 





First Participant Name

First Name*

Middle Name

Last Name*

Phone*
First Participant Date of Birth*
First Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
First Participant Signature*
Second Participant Name

First Name*

Middle Name

Last Name*
Second Participant Date of Birth*
Second Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Third Participant Name

First Name*

Middle Name

Last Name*
Third Participant Date of Birth*
Third Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Fourth Participant Name

First Name*

Middle Name

Last Name*
Fourth Participant Date of Birth*
Fourth Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Fifth Participant Name

First Name*

Middle Name

Last Name*
Fifth Participant Date of Birth*
Fifth Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Sixth Participant Name

First Name*

Middle Name

Last Name*
Sixth Participant Date of Birth*
Sixth Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Seventh Participant Name

First Name*

Middle Name

Last Name*
Seventh Participant Date of Birth*
Seventh Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Eighth Participant Name

First Name*

Middle Name

Last Name*
Eighth Participant Date of Birth*
Eighth Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Ninth Participant Name

First Name*

Middle Name

Last Name*
Ninth Participant Date of Birth*
Ninth Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Tenth Participant Name

First Name*

Middle Name

Last Name*
Tenth Participant Date of Birth*
Tenth Participant Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please list any health conditions, injuries, and relevant surgeries.

Please list your pronouns.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!