Name *

First Name

Last Name

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MM

DD

YYYY

Phone *

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Address *

Address 1

Address 2

City

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Zip/Postal Code

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Before you participate, we want to make sure you understand the important aspects. Please read and consider the following points: Non-Medical Nature: I acknowledge that the wellness activities provided by SparkPhysio, LLC are not medically necessary and are not intended to diagnose, treat, cure, or prevent any disease or condition. No Guaranteed Results: I understand that no guarantees or assurances of any specific results are promised or implied by participating in these wellness activities. Informed of Risks and Benefits: The specific risks and benefits of the activity I will be participating in have been explained to me. I am aware of what to expect and what could happen during the activity. All Questions Answered: All of my questions have been answered to my satisfaction. I feel well-informed about the activity and its potential impact on my well-being. Waiver of Liability: I voluntarily assume asy risks associated with participating in the wellness activities offered by SparkPhysio, LLC. I release SparkPhysio, LLC and its staff from any liability for any injury, harm, or damages that may arise from my participation. Willful Participation: I am entering into this wellness activity willingly and of my own choice. I understand that i have the freedom to decline or stop any activity at any time. By checking "I Agree" and submitting this form, I confirm that i have read and understand the information provided above, and I agree to participate in the SparkPhysio wellness activity with full awareness of its nature, risks, and benefits. I understand that this activity is not a substitute for medical care, and I will consult a medical professional if I have any health concerns.

I agree