Physio & Pilates | Massage | Personal Training

4/210 Queen Victoria St | Nth Fremantle | Western Australia

08 9336 7038
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Studio Liability Release
Agreement for Participating in Personal and Group Training
NB: This is a legal document that affects your rights – please read carefully.
The 'trainer/therapist' refers to the Australian Registered Business ‘Mint WellBeing Pty Ltd’
The 'activity' refers to the participation in personal / group strength, fitness and conditioning training and general advices; as well as pilates, physiotherapy and remedial massage services.
Before commencing exercise or changing your nutritional intake it's important to speak to your doctor and follow their recommendations.
All programs are undertaken at your own risk - it is important to make responsible decisions for yourself. If you are undertaking an exercise and you feel pain, please alert the trainer. I acknowledge that it is a condition of participating in this activity that I do so at my own risk
  • I accept all risks and hereby indemnify and release the trainer/therapist, their agents, affiliates, employees, members, sponsors, promoters and any person or body directly and indirectly associated with the Trainer/Therapist, against all liability (including liability for their negligence and the negligence of others) claims, demands, and proceedings arising out of or connected with my participation in this activity
  • This release and indemnity continues forever and binds my heirs, successors, executors, personal representatives and assigns
  • I acknowledge that participating in this activity may involve a risk of serious injury or even death from various causes including: over exertion, dehydration, equipment failure and accidents with equipment and surroundings
  • I recognise the difficulties associated with the activity and attest I am physically fit to participate safely in the activity and that a qualified medical practitioner has not advised me otherwise
  • I understand the demanding physical nature of this activity. I am not aware of any medical condition, injury or impairment that will be detrimental to my health if I participate in this activity. In the event that I become aware of any medical condition, injury or impairment that may be detrimental to my health if I participate in this activity my Trainer will be immediately informed. By continuing to participate in this activity I accept the risks despite these conditions and am still, and will always be under the terms of this agreement.
 YOU UNDERSTAND THESE WARNINGS WITH YOUR SIGNATURE BELOW: ·        Heat Treatment: When receiving heat treatment, all you should feel is mild comfortable warmth. If you feel any more than this, or if the heat concentrates in any particular spot, you must call your therapist immediately, otherwise you may be in danger of being burned. ·        Electrical Stimulation:
When receiving electrical stimulation, any concentration of the current, or discomfort or pain must be reported immediately to your physiotherapist. Otherwise you may be in danger of sustaining an abnormal skin reaction. This may result in skin and tissue damage. ·       Remedial Massage Therapy only: I fully acknowledge that massage professionals do not diagnose illness or disease, perform any type of spinal manipulation or prescribe medication, and that nothing said throughout this session should be construed as such. ·       Physiotherapy & Remedial Massage: Treatment may be associated with small risks including pain, bruising, infection, burn (thermal treatment only), relaxed / sleepiness, allergy, fainting, aggravation of your condition. The best way to reduce these risks is to answer all the health questions fully and honestly. I acknowledge that I have the right to & will ask for further information about these risks and the treatment.   PHYSIOTHERAPY & MASSAGE THERAPY CONSENT: ·       I confirm that all information given is true and accurate, ·       I understand that I have the right to refuse treatment and that the treatment may be stopped at any time by either myself or the therapist. ·       I acknowledge that to provide appropriate health care and advice it is necessary to answer questions concerning my past and present health status, and I consent for these details to be recorded on my client file notes, and communicated to other health professionals directly involved in my health care.
 ·       I consent for my medical information to be used in an anonymous manner for research purposes and/or to generate practice statistics and the development of improved practice policy and service to benefit clients of Mint WellBeing.
 ·       I understand that providing my email address enlists me to receive the Mint Wellbeing online newsletter, that I may opt out of receiving at any time.
 ·       I understand I may receive Appointment reminders via SMS and/or by phone.
 ·       I consent to be charged for professional services and acknowledge that it is my responsibility to pay my account at the time of consultation.
 ·       I acknowledge that if I do not pay my account I may be charged an administration and debt collection fee.
 ·       I understand that if I do not attend my appointment, or do not give reasonable notice of cancellation, I may be charged a Cancellation Fee.
I certify that I am 18 years or older and have read this document and fully understand it
As a parent or guardian of the participant (a) I agree to the above for myself and on behalf of the participant and (b) I indemnify and will keep indemnified any person or body directly or indirectly associated with the conduct of the activity on the terms referred to.