Janet G. Travell, MD Seminar Seriessm
Manual Trigger Point Therapy (MTT) Program
Registration
Sample Waiver
Every effort is made to teach and practice safe techniques under the supervision of our instructors. Nevertheless, there is always the possibility of injury. Attendees will be required to sign a waiver absolving Myopain Seminars, the program directors, and the instructors of any liability in the event of injury. A sample of the waiver form follows:
I, ________________________ , understand that the Janet G. Travell, MD Seminar Series of Myopain Seminars is a participatory seminar program in which all persons attending the courses are expected to practice on each other. This means that I will allow my fellow participants as well as the workshop instructors to practice evaluation and treatment techniques of manual trigger point therapy throughout my body during the seminars.
I understand that although the risk of any serious harm is minimal, nevertheless there is the possibility of injury. Hematomas may occur and bruising may result.
I understand the risk of injury, though small, is real. I hereby hold the program directors, Dr. Robert Gerwin, and Dr. Jan Dommerholt, the preceptors, Myopain Seminars, and 360 NMT®, harmless for any injury sustained during the course. Also, I hereby hold the program directors, Dr. Robert Gerwin and Dr. Jan Dommerholt, the preceptors, Myopain Seminars, and 360 NMT® harmless for any injury sustained from MTT techniques used in my own practice.
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Signature and Date
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Witness Signature and Date
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