Instructions: Please read the terms and conditions for your participation in a Steady Steps PT workshop. You will receive this by email and will need to electronically sign it and send it back. Thank you!

Consent for Participation

Functions and Activities

I understand the purpose of the Infant Motor Development Class is to teach parents appropriate motor development activities for their infants. A Steady Steps PT Representative will be demonstrating activities with a doll, while I touch my own child. It is my understanding that Steady Steps PT representatives will not be handling or treating my child. I understand that this class is not providing medical guidance or a solution to a medical issue. I also understand that Steady Steps PT is not affiliated with any hospital.

Prior to my participation in such activities, I acknowledge that there could be certain risks associated with the activities, including, by way of example, physical injury due to activity‑related accidents. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

Release of Liability

By signing this Waiver Form, I expressly warrant that my child is healthy to participate in this class and give my permission for my child’s participation. I expressly warrant that the child named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I further release Stead Steps PT and its therapists, employees, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall exclude any gross claims of negligence. This release of liability is also intended to cover all claims that members of the child's or my family or estate, heirs, representatives, or assigns may have against Steady Steps PT or its therapists, employees, or agents.

I further agree to indemnify and hold harmless Steady Steps PT and its therapists, employees, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.

I represent that I am the parent/guardian of my child who is under 18 years of age. I have read the above Consent for Participation and am fully familiar with the contents thereof.

I give permission for the child named above to participate in the activities of Steady Steps PT, including any activities described above. In consideration for allowing the participation of the child in the activities of Steady Step PT, I hereby consent to the Consent for Participation, including the Release of Liability above, on behalf of the child, and agree that this Consent for Participation shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.