CLIENT HEALTH INFORMATION
RELEASE, WAIVER, AND HOLD HARMLESS AGREEMENT
This Release, Waiver and Hold Harmless Agreement is made by and between
YOU and Kathie Engeseth, on the day, month, and year noted below. I hereby
agree to the following:
1) It is my responsibility to discuss my concerns about my health with my physician before
participating in SRT (Soft Stretch Release Techniques) and to obtain my physician’s consents prior to
beginning SRT. It is my responsibility to fully disclose my medical history to Kathie Engeseth before
participating. This disclosure includes, but is not limited to, all injuries, surgeries, and medical or
health-related conditions or illnesses.
2) I understand that participation in SRT or any other exercise may result in accident or injury, and
regardless of the cause of the Injuries, I, both for myself and on behalf of my heirs, assigns, personal
representatives and next of kin;
a) Assume all risk of injury, harm, loss, and/or death while I am participating in SRT.
b) Covenant not to file suit against, and release, waive, and discharge Kathie Engeseth,
participants, lessors and all others from any and all liability to me, my heirs, next of kin,
administrators, BlazeFit, or property owners and assigns for any and all claims, demands,
actions, and causes of any sort of losses or damages on account of injury, illness related to
Covid-19, damages or death caused or alleged to be caused, whether in whole or in part by
negligence of Kathie Engeseth, participants, lessors, and/or others.
3) I fully understand that Kathie Engeseth is not a physician or licensed Medical practitioner of any
kind. Knowing this, I hereby consent to their rendering temporary aid in the event of any injury or
illness, and if deemed necessary, to call a doctor and to seek medical help, including transportation to a
healthcare facility or hospital and I release Kathie Engeseth from any damages or injuries arising from
the rendering of temporary aid.
I have read this Release of Liability and Assumption of the Risk Agreement, and I fully understand it. I understand that by
signing this I have given up substantial rights. I sign this Agreement freely and voluntarily, and without duress or coercion
and I am above eighteen (18) years of age or I am a legally emancipated minor.
I acknowledge the 24 hour cancellation policy and will cancel or reschedule 24 before my appointment time. Failure to
cancel will result in a charge for the session. I also acknowledge the 48 hour refund policy on packages , unless a valid
doctor’s note states medical reason for not receiving services with Kathie Engeseth..