The purpose of this is not to diagnose or treat, while the screen will be performed by trained individuals, participation carries with it a risk of injury that cannot be eliminated regardless of the care taking to avoid such injuries and the undersigned individual shall assume all risk by participating. By submitting information and signing electronically below I do always and forever release any and all rights and claims for all damages and liabilities of any kind of arising out of my participation, against all persons, entities, and agencies involved, including but not limited to: the hosting entity, Powerhouse Physical Therapy, and any other related individuals or entities. I understand that this workshop is not intended to diagnose or treat any injuries. I also agree to be contacted by Powerhouse Physical Therapy in the future. We will not share your personal information here onto per Powerhouse Physical Therapy’s privacy policy. I’ve carefully read this waiver of liability and I understand that I am giving up legal rights, including my right to sue. I acknowledge that I am signing this waiver freely and voluntarily and intent by my signature to be a complete and unconditional release of all liability to the extent allowed by law.

I authorize the Clinic and its Representatives to collect, use, publish, reproduce, exhibit, display, broadcast, or distribute any photographs, videos, films, or any other recordings (collectively, “Media”) of Me receiving services provided by the Clinic for promotional, marketing, commercial, business, or informational purposes. In exchange for sufficient consideration, I give the Clinic my permission for such use and publicity and for such purposes as the Clinic chooses, in its sole discretion. I acknowledge that I may change this consent by providing written notice to the Clinic.