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Thank you for participating in the Amplify Physical Therapy & Performance, LLC event, which consists of a class, a workshop, an injury screen, or a series of classes or workshops, whichever is applicable (the "workshop"), hosted by Amplify Physical Therapy & Performance, LLC and taught by LeeAnn Potochney, PT, DPT (the "instructor").

The information presented during the workshop, including ideas, suggestions, techniques, trainings, exercises, initiations, processes, activities, instructions, and other materials, is educational in nature and is provided only as general information and is not medical advice.

By providing your name and contact information, you represent that you are competent and able to understand the nature and consequences of participating in the workshop, and that you are an adult under the laws of the state of your residence.  Additionally, you understand that your participation in the workshop is strictly voluntary, at your own risk, and that you freely choose to participate. You agree to assume and accept full and complete responsibility for any known and unknown risks associated with your participation in the workshop, including physical injury. You further agree to hold harmless Amplify Physical Therapy & Performance, LLC, LeeAnn Potochney, and Attain Wellness, LLC from any damages or costs, including court and attorney's fees, which may be incurred due to your participation in the workshop.

You agree that the workshop may be filmed or photographed and these videos and images will be used for marketing purposes.

Privacy and Sharing of Information I authorize the clinic and its associated health professionals to collect my personal and medical information as documented by submitting my name and email address. 

Liability Waiver Signature

Thanks for submitting!

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