LIABILITY WAIVER, RELEASE, ASSUMPTION OF RISK AGREEMENT
This form is a legal document and agreement between you and James Thompson Enterprises, LLC (hereinafter collectively referred to as “James Thompson JT” or “Evolve With JT”). It is important that you read and understand it completely. After you have done so, please sign your name and/or check the box as indicated below.
INFORMED CONSENT & SCOPE OF SERVICES
I acknowledge that James Thompson (“JT”) is a sports nutritionist with over 28 years of hands on practical experience. He is NOT a registered nutritionist, dietician, physician or licensed therapist and the scope of his consultation services does not include treatment or diagnosis or cure of specific illnesses or disorders. Always seek the advice of your physician or other qualified medical, health care provider before you start any nutrition or exercise program. By beginning this or any other program, you agree that you have had clearance from your medical professional. I completely acknowledge that I am simply receiving advice and that it is my choice to adhere to the provided advice.
ACCURATE & FULL DISCLOSURE OF HEALTH/MEDICAL INFORMATION
The nutrition and health related advice given by Evolve With JT is solely based on the information provided by the client. All information provided is intended only for the client completing the Background History Questionnaire form provided upon first initial appointment. It is the sole responsibility of the client to provide complete and accurate information and updates about any changes as they occur throughout the course of receiving services. Any misinformation, inaccurate or omitted information may affect the nutritional assessment and/or health related advice. Any misrepresentation of information regarding nutrition, medical conditions, physical limitations or any other pertinent information, is solely the client’s responsibility. Evolve With JT will not be liable. Evolve With JT provides nutrition counseling and other health related recommendations and is not licensed to prevent, diagnose, treat or cure any medical conditions, disease, physical or mental ailments or pain or infirmities. Evolve with JT hereby covenants and agrees that it will keep all client medical information confidential and will take reasonable steps to prevent disclosure of client medical information.
CONFIDENTIALITY OF NUTRITION & EXERCISE PROGRAMS
I understand that throughout the course of receiving services I will come into possession of certain confidential information belonging to Evolve With JT including but not limited to: pre-nutrition checklists, custom nutrition and exercise programs and a host of other additional resources. I, the client, hereby covenant and agree that I will at no time, use this confidential information for my own financial benefit or the financial benefit of others. Further, to the extent allowed by law, I will not disclose or divulge to others, any programs or such confidential information I received from services with Evolve With JT to anyone.
ASSUMPTION OF RISK FOR NUTRITION & SUPPLEMENTS
I recognize that specific foods may create allergic and possible fatal reactions, most specifically, products containing nuts. I have therefore specified any food allergies/ sensitivities I am aware of. I am aware that specific foods may interact with certain medications. I also understand that it is not the responsibility of Evolve with JT to take my medications into consideration when providing nutrition/supplement plan and or other recommendations. I verify that I will discuss such food/supplement reactions and the potential side effects of all of my medications with my doctor or pharmacist and do not hold Evolve With JT responsible for any reactions I may have.
I acknowledge that I am responsible for consulting and receiving permission from my doctor before making any changes to my nutrition. If I am pregnant or lactating, have high cholesterol, high blood pressure, high blood sugar, diabetes, renal disease, gastric by-pass surgery a family history of gout or any other medical condition that requires special dietary restrictions, I verify that I have previously received permission from my physician prior to participating in any services with Evolve With JT and prior to beginning any specific nutrition or other program recommendations designed for my use.
Any advice regarding dietary supplements provided by Evolve With JT is strictly done so by opinion only, and these products may or may not have been approved by the FDA. Any companies or products mentioned by Evolve With JT are not affiliated with Evolve With JT and Evolve With JT is not liable for any negative repercussions as a result of the quality, or legitimacy of their products. By agreeing to these terms, I am accepting that I will not hold Evolve With JT accountable for any issues, health related or non‐health related that may result from consuming a product suggested or recommended by Evolve With JT. I understand that I am responsible for understanding the product I will be consuming and for my own body and the health risks involved in consuming any dietary supplement.
ASSUMPTION OF RISK FOR PHYSICAL ACTIVITY
I agree that if I engage in any physical exercise or activity, including personal or group exercise training, mobility, stretching or rehabilitation with, designed or recommended by Evolve With JT that I do so at my own risk and I assume the risk of any and all injury and/or damage I may suffer, whether it occurs specifically while engaging in physical exercise or not. This includes injury or damage sustained while and/or resulting from previously engaging in any activities with, outlined or recommended by Evolve With JT, at any premises or facility or by using any equipment, whether provided/recommended to you by Evolve With JT or otherwise, including injuries or damages arising out of the negligence, whether active or passive, or any of Evolve With JT’s affiliates, employees, agents, representatives, successors, and assigns. I agree that I am voluntarily participating in the aforementioned activities and I assume all risk of injury, illness, damage, or loss.
In consideration of the following recommendations made by James Thompson Enterprises, LLC, I AGREE – for myself, and for my heirs, children, parents, guardians, executors, personal representatives, assigns and administrators, I forever release, acquit, waive, discharge, and covenant not to sue James Thompson Enterprises, LLC or it’s affiliates, attorneys, spouses, heirs, executors, administrators, successors or assigns. I accept responsibility to pay for any and all financial obligations incurred as a result of any medical assistance or treatment provided in connection with the treatment of any injuries sustained and to not seek reimbursement. I verify that my physician has examined me and certified that I am in good physical condition and have no disease or injury that would impair my performance or physical condition by following the recommendations made by James Thompson Enterprises, LLC. I further certify that no doctor, nurse, or other licensed medical professional has advised me not to participate in a change in my nutrition, supplements or not to participate in physical training for any reason.
I have read this liability waiver, release, and consulting agreement, and I fully understand its terms. I understand that by entering into this agreement I am giving up substantial rights, including the right to sue. I understand that this agreement is incorporated by James Thompson Enterprises, LLC. I also understand that entering into this agreement is a condition precedent to and is consideration for the privilege of participating any a program designed or any recommendations by James Thompson Enterprises, LLC. I acknowledge that I am signing this agreement freely and voluntarily, and intended by my signature to make a complete and unconditional release of all liability to the greatest extent allowed by the laws of the state of Florida. If any portion of this agreement is held invalid, I agree that the balance of it shall nevertheless continue in full force and effect.
BY SIGNING BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.