Life Coaching Informed Consent and Waiver

  • Life Coaching Informed Consent and Waiver

    I,
  •  consent to participate voluntarily in a Live Authentically, LLC Coaching Program (“Program”) and I recognize this Program may contain certain inherent risks.    

    I expressly assume the risks of the Program and I take full responsibility for my life and well-being and all decisions made before, during and after the Program.  

    I agree to observe and obey all posted rules and warnings, and further agree to follow any instructions or directions given by Pam Savino, owner of Live Authentically, LLC.  

    I understand that the information provided at or in conjunction with the Program, including lifestyle choices, dietary recommendations and/or supplement advice is not intended to be a substitute for professional medical advice, diagnosis or treatment that can be provided by my physician, therapist, licensed dietitian or nutritionist, or any other licensed or registered health care professional.   

    I understand that Pam Savino is not a medical or mental health care provider and she is not providing health care, medical or nutrition therapy services or attempting to diagnose, treat or cure in any manner whatsoever, any disease, condition or other physical or mental ailment of the human body.  Rather, she is serving only in her capacity as a coach, educator, mentor and guide.  

    I agree to seek the advice of my physician or a qualified healthcare professional prior to and during the Program regarding any questions or concerns I have about my specific health situation, possible or actual pregnancy, known or suspected food sensitivities or allergies, dietary restrictions, or any medications I am currently taking.  I agree to not disregard professional medical advice or delay seeking professional advice or stop taking any medications without speaking to my physician or health care professional.  

    I agree to disclose to Pam Savino in advance any known or suspected food allergies or sensitivities, any physical limitations that may impact my breathing or movement, or any other health or mental condition that may affect or be affected during the Program. If I suspect that I have a medical problem, I agree to inform Pam Savino immediately.  

    I understand that no claim is made as to the certain efficacy of any nutritional or supplement protocols. Additionally, I understand that this program may also include recommendations in regards to bringing balance to the physical, emotional, mental and spiritual components of my being. These recommendations may include but are not limited to, stress reduction techniques, food modifications, sleep hygiene, corrective stretching and strengthening exercises, range of motion exercises, resistance training, postural exercises, cardiovascular exercise and shoe wear and orthotic recommendations.  I understand that adopting any of these recommendations is voluntary and by choice.  

     I fully understand that all lifestyle recommendations, including but not limited to physical exercise and food are designed with my health, well-being and utmost safety in mind.  I have been informed and understand physical exercise and food modifications have been associated with certain risks, including but not limited to, musculoskeletal injury, spinal injuries, abnormal blood pressure responses, respiratory distress, and in rare instances heart attack or death. Every effort will be made to minimize these risks.   

    Any information that is obtained from my medical history, fitness level, and coaching sessions will be treated as privileged and confidential and will not be released or revealed to any person other than my healthcare providers without my expressed written consent.  

    In the event that I may injure myself or become ill as a result of my participation in this program, I hereby release, discharge, and waive any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands which I have ever had, now have, and could have in the future against Pam Savino, arising from my participation in anything related to the Program, now or in the future.  

    I have carefully read this document and by signing below I consent to all parts of it.  I understand that by signing this release, I voluntarily surrender certain legal rights.   

  • Date Format: MM slash DD slash YYYY
  • Emergency Contact

    In case of an emergency, I authorize Pam Savino to contact: