Mindful Strides Training Acknowledgment and Waiver Form
Please read the information below - carefully and fully. After you have read the information, please sign and date the bottom of this form. Then, email it back to us.
Mindfulness Training is meant to help you become more present in your life while deepening the experience of life itself. It is scientifically shown to improve focus, quality of life, relationships, stress reduction, cognitive flexibility, memory, and more. Fitness Training and Nutrition Counseling are meant to help you improve your overall physical health and well-being.
Mindfulness Training is not mental health care or medical care. Fitness Training and Nutrition Counseling are not meant to treat physical ailments whether related to past injuries, dietary issues or otherwise. The Trainer is not a doctor and does not treat mental or physical conditions. Mindfulness Training is not a replacement for medical, psychological, psychiatric treatment or other treatment. Fitness Training and Nutrition Counseling are not replacements for treating dietary ailments or physical ailments. The Trainer will use tools and structures designed to support overall health and well-being. If you are experiencing mental health issues, neurological issues, addictions, eating disorders, suicidal thoughts, physical ailments, nutritional conditions, you should seek the assistance of appropriate health care professionals. If you feel physically or psychologically stressed to the point that it is interfering with your ability to function, please seek help from your doctor or a professional counselor.
The structure of Mindfulness Training that Mindful Strides utilizes is progressive and incremental. This increases the resilience in your practice and minimizes the potential for ‘overload.’ Generally, in the practice of Mindfulness, latent / different emotions (positive and negative) and different perspectives may arise. Our training structure minimizes any potential difficulties that may come with these occurrences. Unhealed past traumas may also arise. That being said, if you have past traumas and/or find that you have great difficulty in interacting with these variables at any point in time, you should seek a trained mental health professional.
Mindfulness Training may augment therapy if your therapist agrees, but Mindfulness Training is not to be utilized as a medical treatment. Fitness Training is not meant to replace physical therapy, but can be utilized to strengthen muscles during the post-rehabilitation phase (after PT has been completed). Nutrition Counseling is not meant to replace treatment / dietary plans for food-related conditions or allergies.
By participating in Training with Mindful Strides, you confirm that you have read and agree to each statement in this document, including but not limited to the list below, and that you wish to proceed:
· I understand that Training is not offered as a substitute for professional mental health care, medical care, physical therapy, and is not intended to diagnose, treat, or cure any mental health or medical conditions. I also understand the Trainer is not acting as a mental health counselor or a medical professional.
· I understand and agree that I am fully responsible for my well-being during Training, including my choices and decisions.
· I understand that Training is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, injury rehabilitation, dietary conditions, and I will not use Training in place of any form of therapy / treatment.
· I understand that Mindfulness Training can bring up latent / different emotions, different perspectives and, in some cases, unhealed past traumas. If I have past traumas and/or find that I have great difficulty in interacting with certain emotions and perspectives I agree to seek a mental health professional in order to work through them in a therapeutic setting.
· I understand that all comments and ideas offered by the Trainer are solely for the purpose of aiding me in achieving my defined goals and I will disregard any comment or idea offered by the Trainer which is not in my best interest. I have the ability to give my informed consent, and hereby give such consent to the Trainer to assist me in achieving such goals.
· I understand that to the extent that sessions involve mindfulness practices for career or business, the Trainer is not promising outcomes including, but not limited to, increased clientele, profitability and or business/career success.
· I understand that the Trainer will protect my information as confidential unless I state otherwise in writing. If I report child, elder abuse or neglect or threaten to harm myself or someone else, I understand that necessary actions will be taken and my confidentiality agreement is limited in this capacity and confidentiality will not be maintained in these circumstances or if the Trainer is otherwise legally required to release information or is ordered by a court to provide information or to testify, in which circumstance they will do so to the extent the law requires.
· I understand that the use of technology is not always secure and I accept the risks to confidentiality in the use of email, text, phone, and other technology.
· I declare and represent that no promise, inducement or agreement not expressed in this agreement has been made which is leading me to sign this agreement.
Release of Liability, Assumption of Risk and Waiver of Claims Agreement relating to Eric Lieb dba Mindful Strides, its shareholders, officers, directors, independent contractors, subcontractors, employees, facilitators, agents, and its/their successors, assigns, personal representatives, executors, and heirs (referred to as the “Trainer” in the totality of this document).
In consideration of being permitted to participate in Training, I, for myself, my heirs, next of kin, personal representatives or assigns, do hereby covenant not to sue Eric Lieb dba Mindful Strides and release, waive, and discharge Eric Lieb dba Mindful Strides from all liability for injury, accidents, illness, death, loss of income, property damage or any other loss sustained by me as a result of my participation in the training due to any cause whatsoever. I also agree to indemnify and hold harmless Eric Lieb dba Mindful Strides from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including legal costs and fees brought as a result of my involvement in the training and to reimburse them for any such expenses incurred. I expressly agree that this agreement is intended to be as broad and inclusive as is permitted by the law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.