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REQUIRED FORMS

The liability waiver and consent form is required for all participants at Studio Halara. Your booking may be cancelled if the required forms have not been completed. 

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LIABILITY RELEASE

In consideration of my use of the exercise equipment and facilities provided by Studio Halara, LLC (“Studio Halara”),

I expressly agree and contract, on behalf of myself, my heirs, executors, administrators, successors and assigns, that Studio Halara and its insurers, employees, officers, directors, and associates, shall not be liable for any damages arising from personal injuries (including death) sustained by me, or my guest in, on, or about the premises, or as a result of the use of the equipment or facilities, regardless of whether such injuries result, in whole or in part, from the negligence of the company.

By the execution of this agreement, I accept and assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me or my guest, and I hereby fully and forever release and discharge the company, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the use of said equipment and facilities.

I expressly agree to indemnify and hold Studio Halara harmless against any and all claims, demands, damages, rights of action, or causes of action, of any person or entity, that may arise from injuries or damages sustained by me or my guest.

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly. I assume full responsibility for any and all damages, which may incur through participation. Yoga is not a substitute for medical

attention, examination, diagnosis or treatment.

Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant,

become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Studio Halara, and its instructors.

I have read and fully understand and agree to the above terms of this Liability Waiver Agreement.

I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of Colorado.

I agree to be solely responsible for safety and well-being of my guest and myself. I understand that Studio Halara is not required to provide supervision, instruction, or assistance for the use of the facilities and equipment.

I agree to comply with all rules imposed by Studio Halara regarding the use of the facilities and equipment. I agree to conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose.

I understand and acknowledge that the use of exercise equipment involves risk of serious injury, including permanent disability and death.

I understand and agree that Studio Halara is not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.

I understand and agree that my use of the facilities and equipment is only to be undertaken on my own personal time, and that my use of the facilities and equipment is not within the course or scope of my employment.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 Studio Halara (“the Studio”) has put in place preventative measures to reduce the spread of COVID-19; however, the

Studio cannot guarantee that you will not become infected with COVID-19. Further, attending the Studio could increase your risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending the Studio and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Studio employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the Studio or participation in Studio programming (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the Studio, its employees, agents, and representatives, of and from the Studio, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Studio, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Studio program.

I HAVE READ THE FOREGOING WAIVER AND RELEASE OF LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.

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ACUWELLNESS 5NP TREATMENT CONSENT

AcuWellness Treatment Description

5NP is a specialized form of acupuncture performed by placing five thin, sterile, single-use needles in your ears. The needles are generally left in place for 35 – 45 minutes. Treatment time may need to be altered for clinical or training purposes. State Licensed Acupuncturists, Certified Auricular Açu-Technician or  Auricular Açu-Technician administer the treatments.

Voluntary Consent

I hereby voluntarily consent to be treated by acupuncture, and in particular the 5NP protocol. I understand I may be treated with needles and/or small seeds taped to my ears.

I have not been guaranteed any success concerning the uses and effects of 5NP. I understand I am free to discontinue treatment at any time.

Possible Side Effects/Healing Reactions

I understand that acupuncture may result in certain side effects, including local bruising, slight bleeding, fainting, temporary pain and discomfort, and temporary aggravation of symptoms existing before treatment. Conventional medical therapy also may be indicated, either in response to an emergency or as deemed necessary at the discretion of a licensed physician.

Medical Referral

I understand that if my ailment or condition worsens or if a new ailment or condition arises, I should consult a licensed physician. I also understand that if I am currently under a physician’s care I should continue as long as my physician and I deem it necessary and that my 5NP providers do not recommend altering medications or other therapies without first consulting my physician or provider.

Infectious Disease/Clean Needle Procedures

I understand that infectious diseases may be carried through the air, through physical contact, and through body fluids. I understand that 5NP practitioners/trainees follow the prescribed national standards of Universal Precautions to guard against the spread of infection through the use of sterilized, prepackaged, disposable single-use needles.

I further understand that I am responsible for cleaning my ears prior to 5NP treatment.

 

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