General Movement Liability Waiver

"*" indicates required fields

In consideration of being allowed to participate in any way in a Keller Method Vitality Inc. (hereafter known as KMV) in-person or virtual, private or group session, lecture, workshop and/or related events and activities, the undersigned acknowledges, appreciates, and agrees to the following:

  1. While safe and reliable techniques are practiced and adhered; I have been advised and I understand that like any physical conditioning activity or exercise program, with and with out equipment, presents some risks of injury, especially to people who have pre-existing injuries, illness, or medical disabilities.
  2. I also understand that a medical evaluation, most especially if I have a pre-existing condition is required before commencing any program of physical conditioning or exercise. I have and will continue to keep KMV fully informed of any physical condition or disability, which would prevent or limit my participation in an exercise or physical-conditioning program.
  3. Touch during in-person sessions: I understand that in-person instruction with KMV involves physical contact of the instructor, assistant(s) or apprentice teacher(s) with the participant in order to effectively facilitate the teaching process. It is my responsibility to inform KMV if physical contact is not desirable or appropriate.
  4. Private sessions: Everything discussed within the confines of my time together with KMV shall remain confidential and will not be divulged to any third party without my expressed permission.
  5. Group sessions: If I am participating, no identifying information will ever be divulged outside the Group which includes all participants, KMV and any assistant(s) KMV sub-contracts to assist in group sessions.

I knowingly and freely assume all risks of my participation in the programs of KMV and I assume full responsibility for my participation. I willingly agree to comply with the stated and customary terms and conditions for participation. However, if I observe any unusual significant hazard during my participation, I will remove myself from participation and bring such to the attention of KMV immediately.

I for myself and on my behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless KMV and its officers, directors, shareholders, employees, partners, associates, host sites, apprentices, assistants, other employees, other participants, contractors, owner and lessors of the premises in which the activities take place (“releasees”), with respect to any and all injury, disability, death, or loss of damage to person or property.

I have read this release of liability and assumption of risk agreement and fully understand its terms. I understand that i have given up substantial rights by signing it, and sign it freely and voluntarily with out any inducement.
MM slash DD slash YYYY
Clear Signature