For Therapies: Reiki/yoga/Ayurveda/Sound Healing/Massage
I understand that the Therapist/Yoga Teacher does not diagnose disease, illness, or prescribe any treatment or drugs, nor do they provide spinal manipulation. I understand that if I become uncomfortable for any reason that I may ask the Therapist/Yoga Teacher to end the session, and they will end the session. I understand that the Therapist/Yoga Teacher may end the session for any inappropriate behaviour. I have stated all of the conditions that I am aware of, and this information is true and accurate. I will inform the Therapist/Yoga Teacher of any changes in my status.
Consent for Therapy and Waiver of Liability:
For children under 18: The person with Parental responsibility or guardianship for any children under the age of 18, agree to this disclaimer voluntarily and under no duress.
The undersigned (“Client”) hereby freely consents to receipt of massage services from: Raffaella Breare. Client agrees as follows: Client understands and agrees that they will provide the Therapist/Yoga Teacher with complete and accurate health information, and a written referral from Client’s primary healthcare provider if Client is currently receiving care or has a specific medical condition or symptoms for which Client takes medication or receives periodic evaluations or treatment. Client understands that yoga/therapy is designed to be an ancillary health aid and is not suitable for primary medical treatment for any condition.
Client and Therapist/Yoga Teacher will take opportunity to discuss the potential benefits and possible side effects of yoga/therapy and agree upon a course of focused attention and manual therapy for the predetermined goals of stress reduction, relief of muscular discomfort, and/or promotion of general health. Client will take opportunity to ask questions of the Therapist/Yoga Teacher and has received all requested information.
Thai Massage: Client understands that the clothed body will remain clothed at all times for warmth, sense of security, and as a mark of massage therapy professionalism. Client agrees to immediately inform the Therapist/Yoga Teacher of any unusual sensation or discomfort so that the application of pressure during a massage may be adjusted to Client’s level of comfort. Client understands that massage therapy is not sexual in any manner and that any illicit or suggestive remarks or behaviour on the client’s part will result in an immediate termination of the therapy session. Client understands that if the session is terminated for such reason, payment will be expected in full; regardless if the massage is completed or not.
Client hereby assumes full responsibility for receipt of the massage therapy/private consultation, and releases and discharges Therapist/Yoga Teacher from any and all claims, liabilities, damages, actions, or causes of action arising from the therapy received hereunder, including, without limitation, any damages arising from acts of active or passive negligence on the part of the Therapist, to the fullest extent allowed by law.
Client, in registering and booking a consultation/massage, consent for yoga/Therapy and Waiver of Liability (“Consent”), understands and agrees that this Consent will apply to and govern the current and all future yoga/therapy sessions performed by Raffaella Breare
Registering with The Balanced Yoga (TBY) is proof of your intention to execute a complete and unconditional waiver & release of all liability to the full extent of the law and that you are 18 years of age or older and mentally competent to enter into this waiver.
You understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension.
I ( adult or guardian/parent) hereby agree to the following:
1) That I am participating in the Yoga classes, private consultation or any other exercise programs, videos, books, e-books or handouts offered by TBY during which I will receive information and instruction about Yoga, Ayurveda, Sound Healing, Energy healing/Reiki, physical exercise or health. I recognise that exercise requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
2) I understand that it is my responsibility to consult a physician prior to and regarding my participation in the Yoga classes, Yoga consultation, Ayurveda/Therapies consultation, health programs or workshops offered by my instructor or substitute teacher. I represent and warrant that I am physically fit and I have no medical condition, which would prevent my full participation in this classes, health programmes or workshops offered by TBY. I understand that Yoga, Ayurveda and other therapies are not a substitute for medical attention, examination, diagnosis or treatment and I will consult a medical professional for that purpose; yoga, ayurveda and therapies is not recommended and is not safe under certain medical conditions.
3) If I am pregnant I understand that I participate fully at my own risk and that of my unborn child/children.
4) In consideration of being permitted to participate in the yoga/ayurveda/therapies classes, health programmes or workshops, I agree to assume full responsibility for any risks, injuries , damage or liability, known or unknown, which I might incur as a result of participating in the programmes offered by my instructor, The Balanced Yoga or substitute teacher.
5) I understand that from time to time during yoga classes/private consultation, the instructor may physically adjust students’ form and posture. If I do not want such physical adjustments, I will so inform the instructor at each class I attend. I also acknowledge that if I do wish to receive such adjustments, it is my responsibility to inform the instructor when an adjustment has gone as far as I desire at that time.
6) I give permission to TBY to take photograph/images of me/my child/children during the classes, events and workshops for promotional uses. I will be verbally informed when this take place so that I can choose not to participate. TBY has the right to reproduce, use, exhibit, display, broadcast and distribute or create derivative works of these images and recordings in any media now known or later developed. I acknowledge that TBY own the rights to the images. I also waive any right to royalties or any other compensation arising from the use of images and recordings.
7) I specifically agree to indemnify and hold harmless Raffaella Breare and The Balanced Yoga as to any loss, cost, claim, injury, damage or liability, sustained or incurred by participating in the classes, or through my use of the facilities or equipment of TBY which is caused by an act or omission, whether negligent, intentional or otherwise, of an employee, representative, or agent of TBY. I, my heirs, or legal representative forever release waive, discharge and covenant not to sue Raffaella Breare and The Balanced Yoga for any injury or death caused by my participation in the yoga class. My signature and by submitting this for it constitutes my full acceptance of this waiver. I have read the release and waiver of liability and fully understand its consent. I voluntarily agree to the terms and conditions stated above.
- March 2017