I ___________________________ hear by request and consent Little Lion Alchemy and staff to perform rehabilitative, and bodywork treatment and care to myself and my child. I understand and am informed that as in the practice of physical therapy, bodywork, and exercise there are risks involved to myself and my child. I understand that I have the right to ask about these risks and have any questions answered about my or my childs condition and activities to be performed prior to, during, or after sessions. I the undersigned recognize that there are risks involved in the type of treatment and activities offered at Little Lion Alchemy. Therefore, I accept financial responsibility for any injury that I or my child may cause either to yourself or others due to my negligence. Should the above-mentioned parties or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Little Lion Alchemy, their principles, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligence or intentional actor omission while participating in activities and treatments offered at Little Lion Alchemy, at the main office or any other location including my own home. I have carefully read and fully understand the information on this form and have had the opportunity to discuss my condition and concerns with Rebecca Fleming. I consent and authorize Little Lion Alchemy to guide sessions for any and all conditions or limitations noted. I understand I have the right to deny or terminate sessions at any time I see fit. I understand that ultimately my health and my child’s health is my responsibility and I have the right to consult a Medical Doctor and/or Midwife at any point through this process.
