melissasharee.com - Policy, Waiver & Consent

Policy, Waiver & Consent

CLIENT NAME Last, First, Middle

Date of Birth

Address

Telephone

PARENT/GUARDIAN Last, First (If client is under 18)

Do you have recurring sessions or multiple service dates with Melissa Sharee

Are you a DAY PASS client

If you are a DAY PASS client, when is the date of your scheduled Day Pass (If not SKIP)

Please confirm the type of service you are receiving from Melissa Sharee

INSIDE WELLNESS - Pilates Reformer
INSIDE WELLNESS - Restore + Refresh
INSIDE WELLNESS - Day Pass
ELEVATED GRACE - Biblical Life Coaching
ELEVATED GRACE - Pre-Marital or Post-Marital Coaching
ENTERTAINMENT - Artist Development
OTHER

Do you have an physical conditions, limitations or injuries Melissa Sharee should be aware of? If yes, please describe (if no, SKIP)

I understand that sessions are booked for a set amount of time and must begin at the appointed time, not the arrival time. If I am late I lose that time.

Agree

I understand that a cancellation policy is in place & if I fail to cancel within the time frame required for service I'm scheduled to receive, I forfeit session credit or pay in full for booked sessions if I fail to provide appropriate notice.

Agree

I understand that if I am scheduled to work with Melissa Sharee at a studio and need to reschedule I lose the Studio Fee and will repay the cost for the rescheduled date

Agree

I understand there are no refunds, only session credit when applicable according to the booking policy

Agree

I have voluntarily chosen to work under the direction of Melissa Sharee in person and/or virtually.

Agree

I understand that participation in any activity may involve risk of injury, disability, death and damage to property, and while particular rules and personal discipline may reduce the risk - risk of injury does exist.

Agree

In consideration of Melissa Sharee's agreement to instruct, assist and train me, I do forever release and discharge and hereby hold harmless Melissa Sharee Martinez.

Agree

I am aware that it is my responsibility to inform Melissa Sharee of any pre-existing conditions before participating in any activities. I further understand that Melissa Sharee Martinez holds no liability regarding such pre-existing conditions.

Agree

I knowingly and freely assume all such risks, both known and unknown, even if arising from negligence of Melissa Sharee and/or equipment that may malfunction and assume full responsibility for my participation.

Agree

I am employing the coaching services of Melissa Sharee so that I can obtain information & guidance about wellness factors within my own control (nutrition, mental, behavioral, etc) in order to nourish & support my personal development & wellness

Agree

I understand Melissa Sharee is trained & provides insight to enhance my knowledge as it relates to the area I'm developing in. I understand this coaching is NOT a substitute for the diagnosis, treatment, or care of disease by a medical provider

Agree

I agree to comply with Melissa Sharee's conditions of participation, and abide by her policies, including health and safety policies.

Agree

I acknowledge and agree that no warranties or representations have been made to me regarding the result I will achieve from this program and/or activity.

Agree

I acknowledge that I have thoroughly read the Polices, Informed Consent and Waiver of Liability described above and fully understand its contents.

Agree

I certify that I signed as

Client, 18 years old or older
Parent/Guardian of client under 18 years old

I acknowledge that this electronic Waiver & Consent form will remain in effect indefinitely from the date of electronic signature

Agree

My name typed below serves as an electronic signature verifying that I am waiving any right I or my successors might have to bring legal action or assert claim against Melissa Sharee Martinez

I attest that my electronic signature above was signed freely and voluntarily.

Agree

Date of Acknowledgement

Emergency Contact Name

Emergency Contact Telephone

Please confirm the type of service you are receiving from Melissa Sharee