Workshop Consent Landing Page

I’d like to receive occasional emails about future workshops, wellness tips, and updates from Power of Touch Wellness.

Do you have any existing medical conditions, injuries, or previous surgeries?

Yes

Are you currently taking any medications?

Yes

I acknowledge and accept the following terms: I, the undersigned, acknowledge that I am voluntarily participating in a wellness event hosted by Power of Touch Wellness and led by Anita Amato. I understand that: Anita Amato is a Board-Certified Myofascial Trigger Point Therapist and Wellness Strategist, with massage licenses in Pennsylvania and Colorado. While she is trained in therapeutic techniques, this event does not serve as a substitute for professional medical care, diagnosis, or treatment. This event may include gentle yoga, guided meditation, and bodywork techniques that involve physical movement and instruction. It is my responsibility to listen to my body, modify activities as needed, and consult a healthcare provider if necessary. I release, discharge, and hold harmless Anita Amato and Power of Touch Wellness from any liability, claims, or damages resulting from my participation.

I understand that this workshop includes gentle yoga, guided meditation, and self-myofascial release techniques. I acknowledge that I am participating voluntarily and at my own risk.

I recognize that the facilitator is not a medical professional and that the practices offered are intended for general wellness and relaxation, not for the treatment of any medical condition.

I agree to take full responsibility for my own health and well-being during the session. I will listen to my body, modify movements as needed, and stop if I experience any discomfort or pain.

I release and hold harmless the facilitator, Anita Amato, and the event location, Yoga by Romi, from any liability for injuries or conditions that may arise from my participation.

I confirm that I am physically able to participate in this type of activity or have received clearance from my healthcare provider to do so.

I acknowledge that if I am pregnant or become pregnant prior to the event, I will inform the facilitator prior to the workshop. I understand that I am responsible for consulting with my healthcare provider before participating, and I will listen to my body and modify movements as needed.

I understand that while safety measures are taken, participation in any in-person group activity carries some risk of exposure to illness, including COVID-19. I agree to take personal responsibility for my health and will not attend the workshop if I am experiencing symptoms or have been recently exposed.

Please select your preference regarding photography during the event. Note: We always strive to honor your privacy and comfort. No identifying content will be shared without your express permission.

Yes, I consent to photos/videos being taken and used for promotional purposes without limitation.

Yes, but please do not show my face (blur or crop if used).

No, I do not consent to any photos/videos of me being used or shared.

Please Complete Your Consent Form

Before attending our wellness workshops, we kindly ask you to complete this brief consent form.

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