Consent for the Virtual Tai Chi/Wellness Program

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Hands On NJ Physical Therapy
732-548-8068
info@handsonnj-pt.com
www.handsonnj-pt.com

电子邮件地址 *

First Name *

Last Name *

Phone Number *

I understand that I have to do and stay committed to the program to realize results. Some see results immediately while some see it over time. There are no guarantees but most whoever follows the program see desirable results. *

I AGREE

必填

I understand the nature of the Tai Chi/Wellness Program and that I am in good health and proper physical condition to participate in such activity. *

I AGREE

必填

I agree that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the activity. *

I AGREE

必填

I understand that these activities may involve risks and dangers of potential bodily injury and disability. *

I AGREE

必填

I fully accept and assume injuries, all such risks, and all responsibility for injuries, costs, and damages, known or unknown, which might occur as a result of my participation in the activity. *

I AGREE

必填

I understand this program is for fitness and wellness purposes only. This is NOT physical therapy treatment or advice. *

I AGREE

必填

Attendees understand that their statements and questions will be audible/visible to other attendees and possibly to those watching any recorded segments of the program. *

I AGREE

必填

All payments are final with no refunds. This is a recurring membership. You will be billed on the first of each month. If you choose to cancel, you are required to give us a 30 days advance notice. *

I AGREE

必填

By providing your name below is equivalent to signing to agree all of the statements above and to release Hands On NJ Physical Therapy and its affiliates, its Board of Directors and Officers, and its professional staff of any and all liabilities surrounding the Tai Chi/Wellness Pilates programs and services. I further authorize the said parties to use my testimony, picture, name, and personal information in literature, marketing, and advertisement materials. *

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