This form covers all classes and/or programs offered by NEURO NATION PHYSICAL THERAPY AND WELLNESS. Please be sure to read each paragraph.

I/ We, hereby agree to the following:

That I/We am/are participating in group physical therapy exercise/ fitness classes or other programs offered by NEURO NATION PHYSICAL THERAPY AND WELLNESS during which I receive education, information, and instruction about exercise, wellness, and prevention. I recognize that these group physical therapy exercise/ fitness classes and programs may require physical exertion, which may be strenuous. Although unlikely, physical injury could occur. I am fully aware of the risks and hazards involved and I agree to assume any responsibility to any injury. I will follow all instructions and modifications recommended by NEURO NATION PHYSICAL THERAPY AND WELLNESS.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in group physical therapy/fitness classes and/or programs. I represent and warrant that I am physically able to participate in exercise classes and I have no medical condition that would prevent my full participation in these group physical therapy exercise/ fitness classes and or/ programs.

I have read and understand the Exercise Guidelines for participation in Group physical therapy exercise/fitness classes.

I agree to inform NEURO NATION PHYSICAL THERAPY AND WELLNESS of any physical limitations, physical discomforts and/or injuries before or during fitness classes and/or programs, and I take full responsibility for nondisclosure.

I have read the above release waiver of liability and fully understand its contents. I voluntarily agree to its contents. I voluntarily agree to the terms and conditions as stated above.