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Pro10 Rehabilitative Massage and Training, LLC



Assumption of Risk,

Waiver of Liability,

Release and






(hereinafter "Participant"), am an adult, or the parent/legal 

guardian of the participating individual, residing at

for good and valuable mutual consideration in the release of all claims associated with the voluntary receipt of massage therapy treatment and/or fitness training regimen (hereinafter jointly and severally "Activity"), on a fee for services basis, from Pro10 Rehabilitative Massage and Training, LLC, (hereinafter "Provider"), the parties agree as follows:

By signing below, Participant swears, asserts and affirms that the following statements are understood by the Participant and all representations by the Participant are true and accurate.  Participant acknowledges that Provider is offering the Activity in specific reliance upon Participant's statements herein:

            a.)        Participant has consulted a medical professional, has received permission to participate in the Activity, and assumes all risk of participating in the Activity.

            b.)        Participant understands the importance of informing Provider of past and present medical conditions and medications, together with past and present physical trauma or conditions; Participant is responsible for informing Provider in a timely manner of any changes to the Participant's medical or physical condition, or medication. However, Participant understands that Provider is neither a licensed physician nor pharmacist, and that the Provider does NOT diagnose illnesses or injuries, or prescribe medication.

            c.)        Participant acknowledges that the Activity is not a substitute for medical evaluation and treatment by a licensed physician, physical therapist, or other medical professional, nor is the Activity a substitute for approved diet, exercise and/or stretching.

            d.)        Participant acknowledges that the Activity is not a substitute for physician-approved pharmaceutical, over-the-counter, or herbal medications, supplements and therapies.

            e.)        Participant acknowledges that there are inherent risks in participating in the Activity.  Risks include, but are not limited to, pain, soreness, and/or bruising, which may involve but not be limited to muscles, joints, ligaments, bones and skin.  Participant acknowledges that Activity may uncover or reveal previously unknown stress, injury or pain, or may exacerbate a current or previously unknown stress, injury or pain.

            f.)        Participant acknowledges the responsibility to IMMEDIATELY inform Provider of any discomfort felt during the Activity, and to inform the Provider of any discomfort which occurs after the Activity, before any additional Activity is undertaken.

           g.)        Participant acknowledges the opportunity to ask questions regarding the Activity and that all questions have been answered to the Participant's satisfaction.

            h.)        Participant acknowledges that either the Participant or the Provider may terminate the Activity at any time.

By signing below, Participant acknowledgment that they are is in good health and capable of performing the Activities, as well as an acknowledgment of the inherent risks of the Activity and that no amount of care, caution, instruction or expertise can eliminate all risks associated with the Activity.

Participant on his/her own behalf, or as the parent or legal guardian of any minor participant, warrants that Participant has read this Agreement in its entirety, acknowledges the Activity contains inherent risks, which vary with each Participant, and Participant acknowledges that Provider will not have any responsibility for any injury to Participant, or to pay for any costs or expenses incurred by Participant in the event Participant is injured or harmed in any way.

Participant, on behalf of themselves, their heirs, assigns, executors and representatives, hereby agrees to indemnify, defend, release, and hold harmless, the Provider, it's members, officers, agents, employees, owners, and affiliates of any kind, with regard to the herein referenced services, from and against all claims, demands, losses and causes of action, (including court costs and reasonable attorneys' fees), which it has or may have had against the Provider, whether jointly or severally, whether in a representative capacity, whether arising in contract or tort, whether in law or in equity, which claims, demands, losses and causes of action arise from or relate in any way to allegations or demonstrable actions related to the Activity, from the date of commencement of the Activity forward.

If Participant is signing on behalf of a minor child, or any other person, Participant expressly warrants and represents to Provider that they have the legal authority to execute this Agreement on their behalf, including but not limited to, all terms related to the waiver and release and indemnification agreement, and will indemnify Provider for its reliance thereon.

Executed as a sealed instrument as of

I have had sufficient time to read this Agreement, which is a legally binding contract, or to seek legal counsel before signing the same.  I have read and understand this Agreement and agree to be bound by its terms.

Pro10 Rehabilitative Massage and Training, LLC
David J. Hric, Member