For full disclosure, I am fully vaccinated and have received all recommended boosters for working with possibly vulnerable populations. Many of you know me personally, and know that my family has been through many health issues in the past few years.

To keep my vulnerable family members safe & healthy, please do not attend in-person sessions if you, or anyone in your household has any COVID symptoms, cold or flu symptoms, or stomach virus symptoms. You may reschedule your appointment, or let me know if you prefer to keep your time and we can switch to a virtual session through Zoom.

What can you do?

• Provide proof of COVID vaccination and at least 1 bivalent booster

• Wearing a mask is highly encouraged.

• Wash your hands or use provided hand sanitizer when you arrive

What I will do:

• I will wear a mask for our entire session

• I will provide masks and hand sanitizer

• I use a HEPA air purifier in my treatment room that cycles the air less than every 12 minutes

• All equipment and props used will be cleaned after use

• All in-person sessions will only be scheduled with 45-60 minutes between sessions.

I have agreed to participate in a program of progressive physical exercise with a Teacher at Phase Movement.

The exercise program includes cardiovascular conditioning, muscle strength, endurance and flexibility work. The conditioning program utilizes Pilates, activity analysis, hands on adjustments through differing ranges of motions, and other methods of conditioning, strengthening, and stretching. The possible benefits of this exercise program include: improving cardiovascular fitness, muscle strength, endurance, flexibility, body posture and alignment.

I waive, indemnify, exonerate, hold harmless Phase Movement staff or employee of Phase Movement and their assigns for any claims, demands and causes of action (including attorney’s fees) arising out of or pertaining to any loss, damage, injury or death sustained, caused by any negligent act or act of omission or my participation in the Phase Movement program or breach of duty related to Phase Movement, LLC.

This release applies whether or not any claim, demand, action or suite is based upon or alleged to be based on or in part, the negligent act or act of omission or similar conduct of those parties are hereby released and indemnified. I do hereby assume all risk and hazards in volunteering to participate in the Phase Movement program.

I hereby acknowledge that I possess adequate medical and hospitalization insurance coverage in case of injury. I further acknowledge that I might have the right to choose what exercises I do or do not perform in addition to withdrawing from any exercise at any time.

I acknowledge that I have carefully read this consent and fully understand that it is a release of all liability. In addition, I do hereby waive any right that I may have to bring a legal action or assert a claim for injury or loss of any kind against me for my negligence or arising out of or relating to participation by me in any of the activities, or use of the equipment, facilities or services provided to me by Phase Movement.

I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack).

The possibility of certain unusual changes during exercise does exist. They include such conditions as muscle soreness or stiffness, abnormal blood pressure, fainting, disorders of heart beat and instances of heart attack and death. I hereby acknowledge and accept these risks.

To my knowledge, I do not have any limiting physical conditions or disability that would prelude an exercise program.

I hereby certify that I know of no medical problem (except those noted below) that would increase my risk of illness and injury as a result of participation in a regular exercise program.

MEDICAL PROBLEMS (IF ANY)

A physician’s examination should be obtained by all participants prior to involvement in the exercise program. If a participant chooses not to obtain a physician’s permission, she/he must sign the following statement: I have been informed of the need for a physician’s approval or participation in a progressive exercise/fitness program. I fully understand the strenuous nature of the program. I accept complete responsibility for my health and well-being in the voluntary exercise/fitness program and related testing and understand that no responsibility is assumed by the owner or employees of Phase Movement, LLC.