WELLNESS PROGRAM PARTICIPANT CONSENT TERMS

(MONTRI WELLNESS LLC)

I am being asked to read the following material to ensure that I am informed of the nature of Montri Wellness Programs and of how I will participate in it, if I consent to do so. Montri Wellness LLC requires informed consent prior to participation in this program so that I can know the nature and risks of my participation and can decide to participate or not participate in an informed manner. 

PURPOSE Wellness Programs are operated by Montri Wellness LLC. Programs consist of activities to increase physical activity. The goal of Wellness Programming is to increase the level of physical activity and mental awareness of one’s own body through activities that may include but is not specifically or limited to yoga, Pilates, meditative breathing, physical exercise, and participating in discussions and planning related to such promoted activities. 

PROCEDURE Participation may consist of a number of activities. These activities may include but are not specifically or limited to: physical exercise, meditation, and education about mind and body health issues. Please remember that your participation in this program is strictly voluntary and that you are free to discontinue your participation at any time. In the event that I wish to leave the program I may request a refund for any future pre-paid sessions that have not been utilized. This request will be managed on a case by case basis. 

RISKS The risks of participating in Wellness Programming should be minimal for most participants. I will check with a medical provider if I have any concerns about my ability to gradually increase physical activity and utilize other mindfulness/wellness improvement methods. I hereby, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity with MONTRI WELLNESS LLC. 

BENEFITS The main benefit of participation in this program is to increase physical activity and improve knowledge of wellness issues. Additional benefits may include increased strength, improved cardiovascular health, and stress reduction. 

LIABILITY I, being aware of my own health and physical condition, I hereby expressly and affirmatively state that I wish to participate in the. I understand that my participation is voluntary. I further understand that my participation involves risk of injury, including but not limited to serious disabling injuries and even death, which may arise from my participation in this activity and that it is not possible to specifically list every individual injury risk. Knowing the material risks, I expressly assume all of the risk of injury and death that could occur by reason of my participation. I hereby acknowledge and release any representative, agent, and successors from liability for accidental injury or illness which may occur as a result of my participation. 

I have had the opportunity to ask questions, which I have asked and which have been answered to my satisfaction. 

By checking the consent box on my registration page, I hereby give permission to Montri Wellness LLC to use the information provided by me in their data analyses to assist in the development of future programs designed to increase physical activity and wellness.