Southwest Ashiatsu Massage & Bodyworks
Release of Liability and Waiver Form
This Release of Liability and Waiver Agreement (“Agreement”) is made effective as of the first date of services provided or the date executed, which ever is sooner, by and between Southwest Ashiatsu Massage & Bodywork Academy (alternately “Instructor”) and _________________MYSELF__________________, the Student.
- I represent and warrant that I am physically and mentally fit to participate in the Ashiatsu training course provided by Instructor as a trainee, participant, volunteer and/or guest client (collectively, “Student”). By signing this form I understand that I should consult with a physician or other healthcare provider about my intent to participate in this program and provide or receive Ashiatsu services including, specifically but not limited to, any programs facilitated by Instructor. If I have any physical limitations I have discussed my intent to participate in this program with my doctor or physical therapist I have been given appropriate instructions from these healthcare providers so that I know how to modify any practices or Ashiatsu modalities in order to make them safe and appropriate to my abilities, physical capabilities and/or fitness level including how to modify any suggested technique so that it is appropriate to my ability and/or any of my injuries or physical limitations or those of my clients. I understand that my failure to do any of these things may cause me to injure myself or others.
- Whether or not I have any physical limitations, I understand and agree that my personal health and safety and that of my client are at all times my personal responsibility. Instructor does not assume responsibly for my personal health and safety or for the safety of my clients and I shall not hold Instructor responsible for any injury that I cause myself as a result of my choice to participate in the Ashiatsu program, including, without limitation, my choice to attempt any techniques, my choice to follow any instructions, my choice to attempt any modifications or my choice to permit or receive any hands-on or feet-on treatment. My body, my health, my safety and my participation in Ashiatsu are fully and completely my responsibility and I shall not hold Instructor liable for any injuries that I may cause myself or any damages that I may cause others people, persons or property by choosing to participate in Ashiatsu classes provided by Instructor or providing such services to others. I understand I always have the right to leave the class or to not participate in or apply any of the techniques and to modify them as necessary if so directed by my healthcare provider.
- Instructor is not a doctor or healthcare professional and in a program of this nature it is neither the responsibility nor legal responsibility of Instructor to treat injuries, structure the class around any physical limitations (even if discussed) or to specifically teach me any modifications (even if offered) or to prevent or cure injuries based on my physical ability and/or limitations. I assume full responsibility for any injury or damages that may occur to myself or to others based on my actions.
- In consideration of taking a class at Southwest Ashiatsu Massage & Bodywork Academy, LLC’s chosen location (“Location”) I release all and waive any claims I may have or may have here after against the Instructor, the Location or Location owners for any illness, injury or death that may result from this Ashiatsu workshop including but not limited to any causes, without exception, related to the Location. I understand that if I am not willing to undertake these risks than I have the right to leave the Location at any time and not participate in the training program.
- I, my heirs, or legal representatives, irrevocably release and waive any claims I may have now or may have here after against Instructor, Brenda Blakesley, her agents, entities and assigns, and the Location, for my participation in the Ashiatsu workshops provided. I have assumed all risked as described in this waiver and release liability and understand that the study and practice of Ashiatsu is fully my own responsibility.
- I understand that photographs and video may be taken, I consent for their use on social media and may be used by Instructor, the Brenda Blakesley, her agents, entities or assigns, or the Location, by signing this waver I give permission for them to do so.
- I acknowledge that I have carefully read and understand this release and waiver liability form, have had the opportunity to have it reviewed by an attorney prior to signing or participating and/or have waived the right to have it reviewed because I fully understand its contents and accept and acknowledge the risk involved in this type of activity. Once signed this Agreement is valid until terminated in a writing signed by both parties or as required by the laws of the State of Arizona. If any provision of this Agreement is unenforceable it shall not limit the ability of a court or venue of proper jurisdiction to enforce any/all other terms herein.
- If a dispute arises out of or relates to this Agreement or the validity or application of any of the provisions of this Agreement, then, if the dispute cannot be settled through negotiation or mediation, the dispute shall be resolved exclusively by binding arbitration in Pima County. I understand that buy signing this Agreement and participating in the program I am waiving my right to a jury trial but that I shall still have the right to an attorney and the protection of the justice system through arbitration. Further I agree to indemnify, defend and hold harmless Instructor,and the Location or studio (if applicable) and their collective principals, agents, employees, instructors and volunteers from liability to the full legal extent permitted by any applicable laws for the injury or death of any person(s) and/or any damage to property that may result from any and all of my acts or omissions while participating in activities offered.
- All course materials and any intellectual property is confidential, proprietary information and all rights are reserved to Instructor. I shall not reproduce any materials or share the materials with others unless I have received permission in writing.
- I release Instructor from any liability related to the location where the training occurs (the “Location”) without limitation. I have been advised that there is a dog at the Location and that I may be limiting my rights to sue for any injury sustained during the training workshop including but not limited to any related to the Location including but not limited to the dog. It is my intent to fully indemnify the Instructor from all harm, actions, lawsuits, etc, without limitation, and in return, for consideration of this and for payment of the workshop fee(s), I may receive instruction from the Instructor.
I understand that by signing this waiver I release substantial right to sue, and certain rights that my legal heirs or representatives may have against Instructor and the Location. I understand that my signature provides an unconditional release of liability against Instructor, and the location to the greatest extent of Arizona Law and I do so totally and willingly in consideration of the opportunity to receive services and training in Ashiatsu.