Nutrition Coaching Waiver
This form is an important legal document. It explains the risks you are assuming by starting a nutrition coaching program. It is critical that you read and understand it completely. After you have done so, please print your name and email address below.
RELEASE OF LIABILITY FOR RECEIPT OF NUTRITION INFORMATION AND WAIVER OF CLAIMS ARISING FROM RECEIPT OF NUTRITION INFORMATION
The nutrition information provided by Registered Dietitian, Paula Mrowczynski-Hernandez of OLA Nutrition, LLC is designed for and solely intended to be suggestions which may voluntarily be implemented into the diet of the person who submits their consent below (Sugar Runs, LLC Client). Use of any nutrition information provided is completely voluntary and each user is solely responsible for their voluntary choice to implement the dietary suggestions. It is the sole responsibility of the Client to provide complete and accurate information. Any misinformation or omitted information provided by the Client may affect the nutritional assessment or advice. Any misrepresented information is solely the Client’s responsibility and Paula Mrowczynski-Hernandez RD, MEd, CSSD, OLA Nutrition LLC, and Sugar Runs, LLC will not be liable.
Paula Mrowczynski-Hernandez MEd, RD, CSSD provides nutrition consulting and recommendations only and is not licensed to diagnose a medical condition or illness. The Client must consult a physician for any medical advice.
Waiver and Covenant Not to Sue
I have volunteered to participate in nutrition coaching with Sugar Runs, LLC/ Ola Nutrition, LLC and under the direction of Paula Mrowczynski-Hernandez, which will include, but may not be limited to nutritional planning. In consideration of Paula Mrowczynski-Hernandez’s agreement to assist me, I do here and forever release and discharge and hereby hold harmless Sugar Runs, LLC, OLA Nutrition LLC, Paula Mrowczynski-Hernandez and her respective agents, heirs, assigns, contractors, and employees 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 any nutrition coaching including any injuries resulting there from.
Assumption of Risk
Sugar Runs, LLC, Ola Nutrition LLC, and Paula Mrowczynski-Hernandez recommend you consult your physician before undertaking any diet or exercise program.
By implementing the suggestions provided by Paula Mrowczynski-Hernandez, the Client is affirming that she or he has consulted with a medical doctor and has been cleared to implement the suggestions.
Any nutrition information provided is not intended to diagnose, treat, cure or prevent any type of disease or condition. If you need specialized dietary planning to treat, cure, or prevent any type of disease or condition, you should consult with your medical doctor.
If I am pregnant or lactating, have high cholesterol, high blood pressure, high blood sugar, diabetes, renal disease, have had gastric bypass surgery, or currently have (or have had in the past) any other medical condition that requires special dietary restrictions, I must receive permission from my physician before participating in any significant nutrition or exercise changes, or may be advised to seek help from another health professional.
I recognize that specific foods may create allergic and possible fatal reactions. I will therefore specify any food allergies/sensitivities I am aware of on the athlete nutrition questionnaire form. I am aware that specific foods may interact with certain medications. I will therefore specify all prescription and OTC medications on the athlete nutrition questionnaire form, and have discussed the side effects of all of my medications with my doctor or pharmacist.
I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this nutrition coaching program. I understand that results are individual and may vary.
Paula Mrowczynski-Hernandez (Ola Nutrition, LLC) will keep the client’s information private and will only disclose health and nutrition related information with Jessica Reyes of Sugar Runs, LLC if it is related to client's training and recovery. If the client is not working with Jessica Reyes of Sugar Runs, LLC, Ola Nutrition, LLC will only share health and nutrition related information with the client's coach if and when necessary. Paula will not share the client’s health and nutrition related information with any other parties unless compelled to do so by law or with the consent of the client.
Acknowledgement of Understanding:
I have read this waiver of liability, assumption of risk, and indemnity agreement and fully understand its terms, and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.