Balanced Health & Fitness

Waiver and Informed Consent for Diet and Nutrition Coaching

I understand Balanced Health & Fitness and/or Kristen Hillman is not a physician, and the scope of the consultation services does not include treatment or diagnosis of specific illnesses or disorders. If you, the client, suspect you may have an ailment or illness that may require medical attention, then you are encouraged to consult with a licensed physician without delay.

Rather than dealing with treatment of disease, Balanced Health & Fitness and/or Kristen Hillman focuses on wellness and prevention of illness through proper diet and nutrition to achieve optimal health. Balanced Health & Fitness and/or Kristen Hillman primarily educates and motivates clients to assume more personal responsibility for their health by adopting a healthy attitude, lifestyle, and diet.

 While people generally experience greater health and wellness as a result of embracing a healthier attitude, lifestyle, and diet, Balanced Health & Fitness and/or Kristen Hillman does not promise or guarantee protection from future illness.

 By signing this document, you acknowledge that you understand that Balanced Health & Fitness and/or Kristen Hillman is a health consultant and not a physician, and that you should see a doctor if you think you have a medical condition. Balanced Health & Fitness and/or Kristen Hillman will not be held liable for failure to diagnose or treat an illness, nor will she be liable for failure to prevent future illness.

 Additionally, you promise to give Balanced Health & Fitness and/or Kristen Hillman a complete and accurate account of any medical conditions that you may have and any medications that you are taking.

I  understand and agree that the Program requires that I voluntarily engage in an acceptable plan of exercise conditioning. My participation in the Program is done voluntarily and entirely at my own risk. I recognize that the Program may involve strenuous physical activity. I acknowledge and agree that my enrollment and subsequent participation in the Program is voluntary and I do so entirely at my own risk. I understand that no exercise program is without inherent risks and that, regardless of the instruction provided within the Program, the administrators of the Program cannot guarantee my personal safety.

I understand that it is my responsibility to fully disclose to my Program coach(es) any health issues or medications that are relevant to participation in the Program, inform the Program coach(es) if there are activities with which I do not feel comfortable, to cease exercise and report promptly any unusual feelings (e.g. chest discomfort, nausea, difficulty breathing, apparent injury, etc) to the Program coach(es), and to clear my participation in any exercise program with my physician.

I understand that I am expected to attend every scheduled session and to follow instructions set forth in the Program. I understand the potential physical risks involved in the Program and believe that the potential benefits outweigh the risks. I understand that the achievement of health and fitness goals cannot be guaranteed. My participation in the Program is completely voluntary.

I have been informed that the information I disclose during the course of the Program will be treated as  confidential and will consequently not be released or revealed to any person without my express written consent.

I acknowledge and represent that I am 18 years of age or older and have read and understand the contents of this document. I have been made fully aware of and understand the potential risks involved in exercise programs. I hereby consent to those risks and freely and voluntarily agree to participate in an exercise program offered by Kristen Hillman and Balanced Health & Fitness.  I am freely signing this Agreement.

 CLIENT WAIVER & RELEASE OF ALL CLAIMS

I hereby accept all risks associated with my participation in fitness exercise and nutrition programs being offered by Kristen Hillman and Balanced Health & Fitness. In consideration of using the services of Kristen Hillman and Balanced Health & Fitness, I release and forever discharge Kristen Hillman and Balanced Health & Fitness, their employees, including trainers and any other officers, agents, contractors, affiliates, or volunteers (“RELEASEES”) from any and all responsibility or liability from injuries or damages to my person or personal property resulting from or connected with my participation in any of the fitness exercise programs being offered by RELEASEES whether arising from the active or passive negligence of RELEASEES or otherwise.

1. I acknowledge and fully understand that I will be engaging in exercise and training activities that potentially involve the risk of serious injury, permanent disability or death. Other possible risks may include social and economic losses which might result not only from the RELEASEES’ own actions, inactions or negligence, but the actions, inactions or negligence of others, the condition of the private or public premises or any equipment. Further, that there may be other risks not known or not reasonably foreseeable at this time. I hereby assume full responsibility for all the foregoing risks, known and unknown, and accept responsibility for the damages following any injury, permanent disability, or death.

2. I further acknowledge and understand that Kristen Hillman and Balanced Health & Fitness, its personal trainers, coaches, contractors, affiliates, and other employees are not licensed dietitians or physicians and that any information or guidelines provided byKristen Hillman and Balanced Health & Fitness, its personal trainers, coaches, contractors, affiliates, or other employees carries no warranty of any kind, expressed or implied, including, but not limited to, warranties regarding safety or suitability for a particular purpose.

3. Kristen Hillman and Balanced Health & Fitness, its contractors and employees will implement the most effective principals principles to help the participant achieve his or her goals within their scope of practice, but cannot guarantee that its products or workouts will be safe, effective or suitable for everyone. For that reason, all such products, services, programs, techniques and materials embodied in such products and services, are offered without warranties or guarantees of any kind, expressed or implied, and Kristen Hillman and Balanced Health & Fitness and its employees disclaim any liability, loss or damages that may result from their use.

4. I understand that a physician’s approval is highly recommended prior to participating in any fitness exercise program. I have signed the Kristen Hillman and Balanced Health & Fitness Informed Consent Acknowledging Risk form.

5. I have read this document in its entirety and agree to adhere to all its precepts, as well as all other terms and conditions of Kristen Hillman and Balanced Health & Fitness’s fitness exercise programs. I understand the risks and benefits of the programs and any questions I may have had have been answered to my satisfaction. Upon participation, I do hereby discharge, release and hold harmless RELEASEES from any and all liability for damage claims or losses of any kind or character whatsoever resulting from any injury or condition I may suffer, or resulting from my participation in Kristen Hillman and Balanced Health & Fitness’s fitness exercise programs.

6. This agreement applies not only to any and all physical injuries but to any and all claims from the damage to, loss of, or theft of property relating to my participations in Kristen Hillman and Balanced Health & Fitness’s fitness exercise programs.

7. This agreement is intended to be broad and inclusive and shall be governed by and construed in accordance with the laws of Texas. If any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

8. Governing Law: It is the intention of the Parties to this Agreement that this Agreement and the performance under this Agreement, and all suits and special proceedings under this Agreement, be construed in accordance with and governed, to the exclusion of the law of any other forum, by the laws of the State of Texas, without regard to the jurisdiction in which any action or special proceeding may be instituted. Any lawsuit under this Agreement must be brought in the state or federal courts in Harris County, Texas.

9. This document and the accompanying Kristen Hillman and Balanced Health & Fitness, Informed Consent contains the entire agreement between the parties. No other agreement exists between the parties and no representations, verbally or in writing, have been made except as stated herein.

In signing this Waiver and Release of All Claims, I acknowledge and represent that I am 18 years of age or older, that I have read and understand the contents of this document, and that no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. I also agree, for myself and my successors, that the above representations are not mere recitals and that they are binding.