Deep Rooted Wellness and Creative

To ensure accurate and efficient processing, please provide all the requested information in the designated fields. Required fields are clearly marked with an asterisk (*). Completing all necessary entries is crucial for the form to be processed correctly. If you have any questions while completing the form, please feel free to reach out.

I agree to commence in an Exercise/Movement/Health Coaching Program, including but not limited to the following: Cardiovascular Conditioning, Muscular Strength, Muscular Endurance, and Flexibility, Yoga, Nature Informed Coaching, Nature or Forest Therapy, Hiking, Meditation and Mindfulness, Backpacking and that some or all of these can be conducted in nature spaces at agreed upon at parks, or wilderness or outdoor locations.

Exercise Disclaimer

Exercise is not without its risks, and this or any other exercise for that matter could potentially result in injury. The risks include, but are not limited to: dehydration, risk of injury, risk of bodily damage, aggravation of a pre-existing condition, and/or adverse effect of over-exertion such as muscle strain, abnormal blood pressure, fainting, disorders of heartbeat, and very rare instances of heart attack. You assume any and all such risk. To reduce the risk of injury to yourself, before beginning this or any program that involves exercise, you must consult a healthcare provider for appropriate exercise prescription and safety precautions. You must first be medically cleared to participate in such therapy by your physician if deemed to have prior medical issues.

Any advice I or Deep Rooted Wellness and Creatives (“we”) may provide you is in no way intended as a substitute for (physical) medical consultation. We expressly disclaim any and all liability from and in connection with this program. As with any exercise, if at any point you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately and consult a physician.

Waiver of Liability

I have read the Exercise Disclaimer, above, and understand that there are certain dangers, hazards, and risks inherent in programs that involve exercise and the outdoors, including, but not limited to those set forth above, which can cause personal injury, death, and/or property damage. I understand that Deep Rooted Wellness and Creatives, LLC cannot and does not assume liability for any such personal injury, death, or property damage. I am willingly and voluntarily participating in this program and have not been induced to do so by Deep Rooted Wellness and Creatives, LLC or by any other person or entity.

Assumption of Risks

Not withstanding the dangers, hazards, and risks involved, and in consideration of being permitted to participate in these therapy sessions:

• I agree to assume any and all risks surrounding my participation in the sessions and in any activities,  I undertake in connection therewith.

• I release and forever discharge Deep Rooted Wellness and Creatives LLC, its members, agents, employees, independent contractors, and affiliated entities (collectively, the “Releases”) from any and all liability for any injury, damage, loss, cost, or expense (including, without limitation, attorney fees) of any nature that I may at any time have or incur, arising out of or in any way related to any damage,  loss, or injury, including but not limited to pain and suffering and death, that may be sustained by me or by any property belonging to me, while participating in these sessions, and in transit to and from such sessions, if applicable.

I Further Agree and Understand…

• I understand that I must first consult with my physician, doctor, or other medical professional before starting this program to determine if it is right for my physical needs if deemed necessary.

• I have no known health problems or medical conditions which could in any way limit my ability to safely participate, and I assume all health risks associated with this activity.

• I understand that my coach will make every effort possible to preserve client confidentiality and privacy while conducting sessions. However, I agree that because these sessions may be outdoors, there is some risk to confidentiality, including, but not limited to: the possibility of encountering a person one of us knows, and some of our conversation may be overheard by someone.

• I certify that I have adequate insurance to cover any personal injury, damage, or property damage I may experience while participating in these sessions, and/or I agree to personally bear all costs of such injury or damage.

• I agree to communicate to my coach if I am uncomfortable with any of the physical and/or emotional demands of such sessions.

• I certify that I will follow all health and safety guidance issued by the CDC and local authorities regarding wearing masks and maintaining a safe distance. I further agree to any and all COVID-19 policies Deep Rooted Wellness and Creatives may implement to protect my health and the health of others.

• I affirm that I am in good physical condition and do not suffer from any disability or condition that would prevent or limit my participation in the above exercise program.

• My participation with Deep Rooted Wellness and Creatives I hereby waive, release, and forever discharge Deep Rooted Wellness and Creatives and its agents from any claims, demands or causes of action coming forth from my participation in this program.

• I understand that exercise in any capacity is potentially hazardous. I am voluntarily participating in these activities. I understand that these activities involve risk of injury, even death. I agree to assume and accept all risks of injury and death.

• I acknowledge that I have had a physical examination and been given my physician’s permission to participate, or that I have decided to participate without the approval of my physician, and I assume all responsibility for my participation in this program.

• I am proficient in reading and writing the English language and understand what I am signing.

Cancellation Policy: I also understand that Deep Rooted Wellness and Creatives has a 24-hour cancellation policy for in-person and virtual training programs. AND Backpacking or other retreats have a no-refund policy, most events will be held rain or shine, unless Deep Rooted Wellness and Creatives deem the weather dangerous.

If cancellation occurs within 24 hours, the session will be billed as a used session. The session can be rescheduled without penalty if more than 24 hours are given.

**Wild Resilience and Custom Backpacking retreats have a no-refund policy, most events will be held rain or shine.

In case of an emergency, I agree to give Deep Rooted Wellness and Creatives the authority to plan for medical or other necessary care.