By signing below, I acknowledge and agree that Dr. Christa Christianson, in her capacity as a licensed physical therapist, may offer medical advice, evaluations, and treatment recommendations to registered students or their family members as part of her services. This may include advice related to injury prevention, rehabilitation, exercise programming, and bodywork.
I understand that any advice or treatment provided by Dr. Christa is intended to support the health and well-being of the student or family member. However, it is my responsibility to consult with my primary healthcare provider regarding any medical conditions, treatments, or changes in health status.
In consideration of these services, I hereby release and hold harmless Dr. Christa Christianson, Santa Rosa Dance Theater, Dance Evolution Studios Inc and Dance Evolution Physical Therapy Corp. and its staff from any and all liability, claims, or demands arising from the use of any medical advice or treatment recommendations provided. This waiver extends to any physical, emotional, or mental injury, including but not limited to injury resulting from participation in physical therapy, exercise, or other activities.
By signing, I confirm that I understand and agree to the terms of this waiver, and I consent to Dr. Christa providing medical advice to the registered student or family member.
Exercise Waiver and Consent Form for Strength Training, Weight Lifting, and Pilates
1. Consent to Participate in Exercise Activities:I, the undersigned, as the participant or, if under 18, as the parent/legal guardian of the above-named participant, give my consent for participation in exercise activities at Santa Rosa Dance Theater, which may include but are not limited to strength training, weight lifting, and Pilates. I understand these activities are intended to build strength, stability, and endurance.
2. Acknowledgment of Physical Fitness and Medical Condition:I affirm that I am, or my child is, physically fit and able to safely participate in the chosen exercises. I further confirm that neither I nor, if applicable, my child has any medical conditions, injuries, or physical limitations that would prevent safe participation in these activities. I understand that it is my responsibility to consult with a physician before starting any new exercise program if I have questions or concerns about fitness or physical health.
3. Acknowledgment of Risks:I understand that exercise activities such as strength training, weight lifting, and Pilates involve physical exertion and certain inherent risks, including but not limited to muscle strains, joint injuries, and other possible injuries. I acknowledge these risks and accept that injuries, while unlikely, can occur even in a safe, supervised environment.
4. Assumption of Responsibility:I voluntarily assume full responsibility for any risks of injury or damage arising from my or my child’s participation in these exercise activities. I further acknowledge that Santa Rosa Dance Theater, instructors, and staff are not responsible for any injuries or incidents that may occur during these activities.
5. Medical Authorization:In the event of an injury or medical emergency, I authorize the staff or instructor to provide basic first aid and, if necessary, arrange for emergency medical treatment for me or my child. I agree to be responsible for any medical expenses incurred as a result.
6. Release of Liability:In consideration of participation, I hereby release and hold harmless Santa Rosa Dance Theater, its owners, instructors, employees, and agents from any and all claims, liabilities, or expenses that may arise directly or indirectly from my or my child’s participation in these exercise activities, to the fullest extent permitted by law.
7. Acknowledgment and Agreement:I have read and understand this waiver and consent form, and I voluntarily agree to its terms. My consent is a condition of participation in the exercise programs offered by Santa