spre LIABILITY waiver

Studio Evolve spre session

liability waiver form

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.