New Client Inquiry | mikeybudd.com

I understand that Mikey’s Movement Therapy includes physical movements and as with any physical activity, the risk of injury or other damages (known or unknown) are always present and cannot be entirely avoided. It is my responsibility to consult with a physician prior to my participation in the exercise program. I understand I will receive information and instruction; including verbal and physical for guidance. I am aware I may be physically touched, stretched, or adjusted in order to assist and/or prevent injury during particular exercises or postures; I may at anytime request no physical contact from instructor or deny consent when asked. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation from Mikey’s Movement Therapy. I have informed the instructor of any past/present injuries in order to ensure my sessions are conducted safely. Exercise/Yoga are not substitutes for medical attention, examination, diagnosis or treatment. Exercise/Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether or not to practice yoga or engage in physical activity. While engaging in any class or activity operated, organized, arranged or sponsored by Michael Budd, Mikey's Movement Therapy and any other names attached to the business either on or off their premises, I shall do so at my own risk, and hold Michael Budd, associated employees, representatives and agents, forever harmless from any and all loss, claim, injury, damage, or liability sustained or incurred by me. I hereby release Michael Budd from any and all liability for injuries that are not directly and proximately caused by professional. Michael Budd agrees to follow trainer's code of ethics, competent instruction and creating a safe environment for practice. By signing this form, I have read the release and waiver of liability and fully understand its consent. I voluntarily agree to everything stated above.

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Medical Questionnaire & Waiver