Group Workshop/Class Waiver
**Participation in a group workshop/class requires acknowledgement of and agreeance to all statements made below. You will be asked to complete a form to include additional information and signatures acknowledging access to the information below. Any questions regarding these statements can be directed to: email@example.com.
Group Workshop Disclaimer
Group workshops provided by Head2Toe Physical Therapy, LLC dba Charlotte Dance Medicine (CDM) are intended for educational purposes only. They are not intended to delay or substitute for medical advice, diagnosis, or treatment from a physical therapist or other health care professional. While every attempt has been made to provide content that is both accurate and effective, medical information evolves constantly. Therefore, CDM content may not be current, complete, or exhaustive, nor should you rely on such information to recommend a course of treatment for yourself or any other individual. No claims are made that content use will resolve any health problem and reliance on and use of CDM content is solely at your own risk.
Group Class Disclaimer
Group classes provided by CDM may not be appropriate for all individuals, specifically with regards to current/previous injury or medical status. Individuals who have not been cleared by a physician to participate in exercise should not participate in group classes with CDM. Group classes are not intended to delay or substitute for medical advice, diagnosis, or treatment from a physical therapist or other health care professional. No claims are made that content use will resolve any health problem and reliance on and use of CDM content is solely at your own risk.
Informed Consent to Participation in Group Workshops/Classes
1. I do hereby voluntarily consent to participation in the workshops/classes provided by CDM in the manner in which they are intended and described in the disclaimer statements above.
2. I am aware that the workshop/class environment may unintentionally expose my status as a participant.
3. I understand that inherent risks are possible, as in all healthcare practices, including but not limited to: changes to vitals, pain, and muscle soreness. I accept that the workshop facilitator/class instructor will act in my best interest but cannot always anticipate individual reactions.
4. I agree to self-management of individual reactions including but not limited to: modification of position or movement and partial or full discontinuation of participation in the event of an impending injury.
5. I accept that the workshop facilitator/class instructor, CDM, nor the hosting facility are liable for any injury or damages to person or property resulting from participation in a workshop/class.
6. I confirm that all information disclosed, including current injuries and ongoing medical issues, is complete and updated to the best of my knowledge and I agree to update workshop facilitator/class instructor and CDM immediately with any changes.
7. I acknowledge that this Waiver may be requested by the host facility for liability purposes. I agree that CDM cannot guarantee the privacy practices of the host facility but any questions regarding this can be emailed to: firstname.lastname@example.org and your concerns will be forwarded to the host facility for clarification.
8. For minor-age dancers participating in workshops: As the parent/guardian of the named minor, I understand I am welcome and encouraged to accompany my child to the workshop and remain for its entirety. I acknowledge that the workshop facilitator, CDM, nor the host facility, is responsible for providing adult supervision for my child outside of the scheduled workshop time or outside the room in which the workshop is held. I acknowledge this includes, but is not limited to, use of bathrooms or exiting the room/building following conclusion of the workshop.
Media/Public Relations Authorization for the Use and Disclosure of Protected Health Information
1. Participant authorizes CDM to disclose to media representatives and/or public affairs staff members participation status and any protected health information disclosed during workshops/classes for purposes of publicity, promotion, education or publication in print, broadcast and electronic and social media. This authorization includes likeness on photo, videotape and digital media.
2. Participant understands that they will not be compensated in any way for the taking or use of photographs, films, audio and/or videotapes, or the publishing of any article or information.