Liability Release, Informed Consent for Participation
I desire to participate voluntarily in physical therapy, Pilates classes, exercise program or bodywork with Ashli Gauthier PT, DPT and have obtained permission from my physician prior to the commencement of any exercise program.
I understand that the purpose of my sessions is to develop and maintain wellness and physical fitness.
In consideration for being allowed to participate in physical therapy, exercise, or bodywork programs with Ashli Gauthier PT, DPT, I agree to assume the risk of such sessions online or in person, and further agree to hold harmless Gauthier Physical Therapy and Pilates/Ashli Gauthier, PT, DPT from any and all claims, suits, losses, or related causes of action for damages, including, but not limited to, such claims that may result from my injury or death- accidental or otherwise- during or arising in any way from my sessions.
I affirm that I have no known medical conditions that prevent me from participating,
and agree to keep Ashli Gauthier, PT, DPT updated as to any changes in my medical and physical condition that are relevant.
I also agree to not hold Gauthier Physical Therapy and Pilates responsible for any breach of information or technical issues if utilizing telehealth or tele-Pilates services.
I have read this form in its entirety and my questions regarding participation in Gauthier Physical Therapy and Pilates programs have been answered to my satisfaction.
When purchasing online classes, you will be asked to type Y to agree with this waiver. In person clients will sign in the studio.
In the event you need to cancel your session please notify us within 48 hours of your scheduled session, for all group classes, semi-privates and private sessions. We do our best to help you reschedule for the same or following week.
We strive to provide timely and convenient scheduling for all our clients. In the event you cancel less than 48 before your session you will be charged $50 for a private session, 50% of the cost for your group session. If your partner late cancels for a semi-private session you will be responsible for paying for the full session as a private.
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