Logan Kinei, LLC Terms & Conditions, Waiver, and Release
WAIVER, RELEASE, AND ASSUMPTION OF RISK FORM
This form is an important legal document. This is an explanation of the risks you are assuming by performing a fitness and/or physical therapy program. Please ensure that you read and understand this completely. After you have done so, please print your name in the appropriate area, then sign and date.
WAIVER, INFORMED CONSENT, AND COVENANT NOT TO SUE
I have volunteered to participate in a program of physical fitness training and/or physical therapy under the direction of Logan Kinei, LLC. The program will include, but many not be limited to, mobility/flexibility training, cardiovascular training, balance, dynamic motor control, strength training, breath work, meditation, and discourse. In consideration of Logan Kinei, LLC agreement to instruct, assist, treat, and train me, I do here and forever release and discharge and hereby hold Logan Kinei, LLC harmless from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any fitness and/or physical therapy program including any injuries resulting there from. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OF BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT.
ASSUMPTION OF RISK
I hereby acknowledge that I have signed up for a unique combination of fitness training and physical therapy. My session will be tailored to my needs – ranging from more physical therapy focus to more fitness training focus. I RECOGNIZE THAT EXERCISE MIGHT BE DIFFICULT AND STRENUOUS AND THAT THERE ARE DANGERS INHERENT WITH EXERCISE/FITNESS FOR SOME INDIVIDUALS. I acknowledge the possibility of certain unusual physical changes during fitness and movement training does exist. These changes could include, but are not limited to, abnormal changes to blood pressure, fainting, irregularities in heartbeat, heart attack, and, in rare instances, death.
I understand that as a result of my participation in an fitness/movement training program, I could suffer an injury or physical disorder that could result in by becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life.
I recognize that an examination by a licensed physician is recommended to be prior to involvement in a fitness or treatment program with Logan Kinei, LLC. I also recognize that direct access physical therapy is legal in New Jersey and Pennsylvania, which allows licensed Doctor of Physical Therapy to assess and treat without physician referral for up to 30 days in Pennsylvania, and unlimited in New Jersey with positive progress and results. At the onset of a medical problem outside of a physical therapy scope of practice, you will be referred out to another health care professional as appropriate.
I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate.
I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand that results are individual and will vary.
I ACKNOWLEDGE THAT I HAVE BEEN ADVISED BY MY PHYSICAL THERAPIST THAT HE HAS A FINANCIAL OR OWNERSHIP INTEREST IN THE FACILITY OR ENTITY TO WHICH HE HAS REFERRED ME, AND THAT HE HAS ADVISED ME THAT I AM FREE TO CHOOSE ANOTHER FACILITY OR ENTITY TO PROVIDE THE SERVICE, DRUG, DEVICE OR EQUIPMENT.
TREATMENT WITH LOGAN KINEI, LLC MAY INCLUDE A RECOMMENDATION FOR FURTHER DIAGNOSTIC TESTING, FOR VARIOUS FORMS OF THERAPY OR TREATMENT, OR FOR DRUGS OR DEVICES. PENNSYLVANIA LAW REQUIRES YOUR PHYSICAL THERAPIST TO DISCLOSE TO YOU ANY FINANCIAL INTEREST HE HAS IN TREATMENT FACILITIES, TESTING LABORATORIES, MEDICAL EQUIPMENT SUPPLIES, PHARMACEUTICAL COMPANIES AND PHARMACIES TO WHICH HE REFERS YOU. HE MUST ALSO ADVISE YOU THAT YOU ARE FREE TO CHOOSE ANOTHER FACILITY OR ENTITY TO PROVIDE THE SERVICE, DRUG, DEVICE OR EQUIPMENT. (ACT 66-1988)
POP UP/GROUP CLASSES
I hereby acknowledge that I have signed up for a unique combination of wellness practices centered on spirituality, not religion. I acknowledge that in a “POP UP” Class or any group setting, no physical therapy skills will be performed by Logan Kinei, LLC. Logan Kinei, LLC does not put a timeline on reducing pain or injuries, as this varies for each individual.
If in a group setting, I acknowledge that it is up to me to modified my work as I am able. If I am unsure how to do so, I will clearly communicate this with Logan Kinei, LLC immediately.
I hereby acknowledge that I have been advised that if appropriate to my treatment or training my Logan Kinei, LLC care may require the therapist (for treatment) and/or trainer (for cues and teaching purposes) to appropriately place his or her hands on my head, face, neck, shoulders, legs, hips, feet, lower back, chest, groin or buttocks areas. I hereby consent and agree to the appropriate use of such treatment and fitness training techniques. If I feel uncomfortable or that the methods being uses are inappropriate at any time, I will alert Logan Kinei, LLC immediately. Soreness or increase in symptoms for up to, but not limited to, 2 days following treatment and/or training is common.
I agree to alert Logan Kinei, LLC of all and any allergies, illnesses, injuries, medications, supplements, etc. that may affect my health or outcome while working with Logan Kinei, LLC.
I further understand and agree that for therapy and training to be effective, I must keep my scheduled appointments unless unexpected circumstances prevent me from doing so. In such an event, I will contact Logan Kinei, LLC as soon as possible. I agree to be honest with Logan Kinei, LLC about my compliance, intentions, and to work hard to bet the best possible results. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST LOGAN KINEI, LLC.
By agreeing, checking and submitting on LoganKinei.com, you accept consent to treatment and/or training and the working relationship with Logan Kinei, LLC.
The services to be provided by the Logan Kinei to the client are group and/or one-on-one in- person or video conferencing, as agreed jointly with the client. Teaching may address any issues, concerns, topics or questions proposed by the client. No topic is off limits, however the coach reserves the right to make the decision on whether they can be of assistance with the topic.
Logan Kinei is setting out to help you improve upon your life to reach your vision and intentions. Other services include intention setting, deep discussion. We will not have answers, but will provide advice and guidance to help the client find clarity and awareness.
Additionally, the client may be asked to reflect on difficult topics or situations which may result in an expression of emotions.
Throughout the working relationship, the coach will engage in direct and personal conversations. The client understands that successful teaching requires a co-active collaborative approach between client and coach. In the teaching relationship, the teacher plays the role of an advisor of change, but it is the client's responsibility to enact or bring about the change.
If the client believes the teaching is not working as desired, the client will communicate this with the coach as soon as possible. The teacher and client will have a discussion, however there are times where the approaches will not work and that is good. At that point in time, the client or the teacher reserves the right to cancel the working relationship. If the teacher cancels, any previously scheduled and payed-for sessions will be refunded. If the client cancels, refund is up to the discretion of the teacher.
You are very much encouraged to talk more with the teacher as to receive a better understanding of what coaching is about and how to get the most out of it.
The client also agrees to disclose details of the past or present psychological or psychiatric treatment, medical conditions, pregnancy . Likewise, therapy and other modes of professional or medical psychological examination shall not be considered equivalent to coaching.
The Logan Kinei: Wellness Coaches are not registered psychologists or psychiatrists, nor a Licensed Professional Counselor, however Shaun Logan is licensed physical therapist. Logan Kinei: Wellness Coaching is not physical therapy as it pertains to diagnosis and treatment of pain or injury of the human movement system. If physical therapy skills are required and requested pertaining to the human movement system, that will take place at a different time, under a different contract.
Logan Kinei does not engage in therapy with my clients. In entering into the teaching relationship, and signing the agreement, you are agreeing that if any mental health difficulties deemed out of Logan Kinei’s scope of practice arise during the course of the coaching relationship, you will notify Logan Kinei immediately so that I can discuss with you an appropriate referral.
Though Logan Kinei, LLC is not a HIPAA covered entity, all information about the coach/client relationship will remain strictly confidential except in very rare circumstances where decreed by law; ie. where the court might issue a subpoena for the file or information.
If you wish for me as your coach to speak to someone outside our interactions, you need to give me written permission (original letter, fax or email) to do so. Exceptions to confidentiality of course relate to circumstances such as intent to seriously harm someone, child abuse, thoughts of suicide etc. Otherwise, all remaining information is kept confidential.
It is also important to note that in some situations, it is important to be aware of the use of technology in that for some clients, there is a risk in using certain media such as the internet, mobile phones, social media, etc. If you use these to communicate with Logan Kinei, then we will assume that it is appropriate to continue to do so in future interactions with you.
Logan Kinei, LLC strongly enforces a 24 hour cancellation policy. All sessions may be canceled or re-scheduled 24 hours prior to the start of the session without penalty.
If a Logan Kinei: Wellness Coaching session is cancelled in less than 24 hours of the scheduled session time, the session and payment will be forfeited. All circumstances will be reviewed by Logan Kinei, LLC and will be handled on an individual basis. However, Logan Kinei, LLC reserves the right to enforce the policy regardless of circumstance.
The client has the option to terminate the coaching agreement at any point after signing the contract. Refunds will be at the discretion of Logan Kinei, LLC. Otherwise, the client agrees to coaching for the duration of the contracted period.
Release of Liability
Logan Kinei is a service that provides physical movement, breathing, meditation, and discourse to specific individuals and/or groups. The client is aware that teaching is in no way to be construed or substituted as psychological counseling or any other type of therapy or medical advice. At all times, Logan Kinei’s teachers will exercise their best professional efforts, skills and care of ensuring the client is coached to meet their unique needs. We are not licensed therapists, social workers, or counselors. We are not affiliated in any way with any of the practices we teach including, but not limited to, Functional Range Conditioning and Wim Hof Method.
The client understands and acknowledges the coach will not be liable legally or otherwise, for the actions the client may or may not undertake as a result of the coaching sessions. No assumption of responsibility is made, or given, and the client requesting such advice agrees not to hold Logan Kinei or their teachers responsible or liable in any form or fashion, for such actions taken of their own accord. The method and process by which this advice and direction are given in no manner whatsoever, written or verbal, constitutes an agreement or liability on the part of the provider and is acknowledged to be different in many ways than clinical and medical counseling.
I, the client, agree that using any of Logan Kinei services are entirely at my own risk. Wellness services are provided "as is", without warranty of any kind, either expressed or implied, including without limitation any warranty for information services, coaching, uninterrupted access, or products and services provided through or in connection with the service. This service is requested at the client's own choice and with inherent singular responsibility.
Any actions or lack of actions, taken by the client of such advice is done so solely by choice and responsibility of me, the client, and is neither the responsibility nor liability of Logan Kinei or their teachers (Provider). I, the client, takes full responsibility in the decisions they make after being coached as well as the consequences. I, the client, enters into coaching with full understanding that I am responsible for creating their own results. Periodically, Logan Kinei or their teachers (Provider) may provide links to other web sites or written print material which may be of value, interest and convenience to you. This does not constitute endorsement of material at those sites or any associated organization product of service. It is the responsibility of you, the client, to make your own informed decision about the accuracy of the information at those sites and print material including their privacy policies. In no event shall Logan Kinei or their teachers (Provider) be liable for any incident or consequential damages resulting from use of said material.
By checking the box and hitting submit on the form on LoganKinei.com, you indicate that you fully understand and are in agreement with the information outlined above; and you accept the terms of this agreement with Logan Kinei, LLC.