Waiver & Release Form
                                                         Prairie Wellness LLC

 

             

              I understand that yoga/mindfulness meditation/massage therapy includes physical movement as well as an opportunity for relaxation, stress re-education and release of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity and ask for support from the instructor. I assume responsibility for any and all damages which may be incurred through participation.
I understand that there is no implied or stated guarantee of success or effectiveness of individual techniques or series of appointments and I acknowledge that these modalities as well as information exchanged during any wellness session is confidential. These modalities of yoga/mindfulness meditation/massage therapy are not a substitute for medical attention, diagnosis or examination. They are not recommended and are not safe under certain medical conditions. By checking the box associated with this release form I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program.
In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, then checking the box verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga/mindfulness meditation/massage therapy and that participation is at my own risk.
I hereby agree to irrevocably waive and release any claims that I have now or may have hereafter against Prairie Wellness LLC and its instructor, Laurie Sullivan, Prairie House Farms LLC, Prairie House Property LLC and owners Laurie and Lawrence P Sullivan. I have read and fully understand and agree tot he above terms of this Liability Waiver Agreement. I am checking the associated box voluntarily and recognize that my checking the box serves as a complete and unconditional release of all liability to the greatest extent allowed by the law in the State of Wisconsin.  ,