INFORMED CONSENT & WAIVER AND RELEASE OF LIABILITY THIS FORM IS AN IMPORTANT LEGAL DOCUMENT. IT EXPLAINS THE RISKS YOU ARE ASSUMING BY PARTICIPATING IN AN AQUATIC THERAPY AND FITNESS PROGRAM. THIS IS A LEGAL DOCUMENT WHICH YOU AGREE TO A FULL AND COMPLETE WAIVER OF ANY AND ALL CLAIMS AND LIABILITY AGAINST Umamiflow aquatic therapy.  IT IS CRITICAL THAT YOU COMPLETELY READ AND UNDERSTAND THIS FORM BEFORE ACCEPTING these Terms & Conditions.  IF YOU DO NOT UNDERSTAND ALL OF THE FOLLOWING, PLEASE DO NOT ACCEPT UNTIL YOU HAVE OBTAINED THE ADVICE OF A FAMILY MEMBER OR ATTORNEY.

 

I understand that by signing the following Informed Consent & Waiver and Release of Liability Agreement, I accept full and complete risk and liability for any injury or harm that may occur while receiving aquatic therapy and/or aquatic fitness therapy from Umamiflow aquatic therapy and release any claim for injury. I acknowledge, understand, and agree as follows:

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1. Participation in an aquatic therapy program is voluntary.

2. There are inherent risks in participating in activities in the water including, but not limited to: slips, falls, entrapment, infection, skin irritation, chemical exposure and sensitivity, sun exposure, sunburn, hypothermia, hyperthermia, low blood sugar, skin, eye, respiratory distress, general fatigue, syncope, seizure, changes in blood pressure, disorders of heart rhythm, instances of heart attack, drowning, death, increased or new onset soreness, sensitivity, or pain after mobilization, manipulation, stretching, or exercise, generalized fatigue, overuse injury, fractures, and partial and/or total paralysis.

3. By participating in Umamiflow aquatic therapy’s program, I accept these risks.

4. Each person has a different capacity for participating in such activities. It is my obligation to inform Umamiflow aquatic therapy of any changes in my health status and any aquatic therapy related issues I may have or am aware of that might affect my safety or the safety of someone else. I also understand that it is my obligation to stop therapy and notify Umamiflow aquatic therapy immediately if I experience any symptoms such as fatigue, shortness of breath, chest discomfort, or similar occurrence. 

5. I understand that while in therapy the staff of Umamiflow aquatic therapy may periodically monitor my vital signs and will take reasonable precautions to determine if an observable or known potentially hazardous situation exist.

6. I acknowledge that an examination by a physician should be obtained prior to involvement in an aquatic therapy or aquatic fitness program. If I have chosen not to obtain a physician’s permission prior to beginning aquatic therapy, I hereby agree that I am doing so at my own risk.

7. Aquatic physical therapy and aquatic fitness have many potential benefits including: decreased pain, improved cardiovascular fitness, strength, endurance, flexibility, posture, and balance, but Umamiflow aquatic therapy does not guarantee or assure that I will receive any or some of these benefits. 

8. I will notify Umamiflow aquatic therapy of the treatment I participate in and I may withdraw from treatment at any time.

9. I hereby release and indemnify Tim Laurel and Umamiflow aquatic therapy from any present or future responsibility or liability for any and all personal injury, economic damages, property damages, and/or wrongful death that is, or may be, caused by, or relate to, the aquatic therapy and/or aquatic fitness I receive from Umamiflow aquatic therapy.

 

I acknowledge that I have read this Informed Consent & Waiver and Release of Liability document in its entirety and agree to be bound by all terms, conditions waivers and releases. I also acknowledge that the risks identified above are not the only risks in participation in Umamiflow aquatic therapy.