Client/Participant Name: *

First Name

Last Name

Date *

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Address *

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Address 2

City

State/Province

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For services provided by Anna Sea *

I, the undersigned, understand that the wellness services provided by Anna Sea may include physical fitness training, nutrition coaching, and mindfulness-based practices. I acknowledge that while these services support general health and well-being, they are not a substitute for professional medical or mental health care. I voluntarily choose to participate in these services and assume full responsibility for my health, safety, and personal decisions.

First Name

Last Name

Physical Activity Disclaimer *

I understand that physical fitness sessions may include strength training, cardiovascular activity, stretching, mobility exercises, and other physically demanding movements. I acknowledge that participation carries inherent risks, including but not limited to muscle soreness, sprains, strains, falls, or more serious injuries. I take full responsibility for listening to my body, modifying activities as needed, and seeking medical support when necessary.
I affirm that I am not currently injured, and I understand that Anna Sea does not provide rehabilitation, injury treatment, or physical therapy services. If I am recovering from an injury or have any medical condition affecting my movement or safety, I agree to consult with a licensed healthcare professional before participating.

First Name

Last Name

Nutrition Coaching Disclaimer *

I understand that all nutrition coaching provided by Anna Sea is for educational and general wellness purposes only. These services are not intended to diagnose, treat, or cure any disease or medical condition, nor do they replace the advice or treatment of a licensed physician or registered dietitian. I take full responsibility for consulting with a healthcare provider before making dietary or supplement changes.

First Name

Last Name

Mental Health & Scope of Practice Disclaimer *

I understand that Anna Sea is not a licensed therapist, psychologist, or mental health provider, and does not offer clinical mental health care. Her services do not include the diagnosis or treatment of any psychological or psychiatric conditions, including but not limited to: - Eating disorders (e.g., anorexia, bulimia, binge eating disorder) - Body dysmorphia or body image-related conditions - Anxiety, depression, panic attacks, or mood disorders - PTSD, trauma, or any diagnosed mental health condition Any mindfulness or meditation techniques offered are for general stress management and emotional support only. These are not a replacement for therapy, counseling, or psychiatric care. I acknowledge that it is my responsibility to seek professional mental health support for any emotional or psychological concerns.

First Name

Last Name

Assumption of Risk & Waiver of Liability *

I understand that participation in services with Anna Sea is voluntary and involves inherent risks. I assume full responsibility for any and all injuries, conditions, or adverse effects I may experience as a result of participation — including those that may result from ordinary negligence on the part of Anna Sea or her affiliates. I agree to complete all required intake forms and provide accurate health information prior to participating in any services.

First Name

Last Name

Release of Liability *

In consideration of being permitted to participate in services offered by Anna Sea, I, for myself and on behalf of my heirs, legal representatives, and assigns, do hereby knowingly and voluntarily waive, release, and discharge Anna Sea and any of her agents, contractors, or collaborators from any and all claims, liabilities, demands, or causes of action — including but not limited to those arising from ordinary negligence — related to my participation in her services. If any part of this agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

First Name

Last Name

Acknowledgment *

I confirm that I have read this entire waiver and fully understand its contents. I have had the opportunity to ask questions and receive answers. I understand the nature of the services being provided and the risks involved, and I sign this document freely and voluntarily with full knowledge of its legal significance.

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Last Name

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Participant Signature *

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Last Name

Date *

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