I understand that this preventative program qualifies as alternative therapy AND IS NOT a form of physical therapy. For greater certainty, I understand that this preventive program falls outside the jurisdiction of the Saskatchewan College of Physical Therapists. By affixing my signature hereto, I HEREBY CONSENT to engaging in this preventative program on the explicit understanding that this preventive program qualifies as alternative therapy AND NOT physical therapy.

I understand this preventative program may include exercises to build the cardio-pulmonary system (heart and lung conditioning), the musculoskeletal system (which involves muscular strength, endurance, flexibility, and joint mobility), and improve body composition (increasing muscle mass, increasing bone density, and decreasing body fat). Exercises may include aerobic activities (such as walking, running, bicycle riding, rowing, group aerobics, swimming, etc), resistance training (such as lifting dumbbells, barbells, other weighted objects, or body weight), agility exercises (cutting, changing direction, footwork drills), power/plyometric exercises (jumping, explosive weight lifting, sprinting, bounding), movement re-education (improving coordination of the body to improve efficient and pain-free movement), as well as stretching or mobility exercises to improve joint range of motion and muscle flexibility.

Description of Potential Risks:

I understand that the reaction of the heart, lung, blood vessels as well as other systems to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during the following exercise, which include abnormalities of blood pressure or heart attacks as well as other side effects. Use of weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not consistently followed. I understand that Kristi Barker and Reach Rehab, the party(ies) providing the preventative program, shall not be liable for any damages arising from personal injuries sustained by me during and/or arising from the preventative program. I am taking part in this preventative program at my own risk. I assume full responsibility for any injuries or damages which may occur during and/or arising from the preventative program. I hereby fully and forever release, remise and discharge Kristi Barker and Reach Rehab, their successors, agents and assigns from all claims, demands, damages, rights of action, past, present and future. I hereby affirm, warrant and agree that I am in good physical condition and that I am not aware of having any disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition.

Description of Potential Benefits:

I understand that a program of regular exercise for the heart, lungs, muscles and joints has many benefits associated with it. These may include a decrease in body fat, improvement in blood pressure, improvement in physiological function, decrease in heart disease, and improvement in movement and pain. I have read the foregoing information and understand it. Any questions, which may have occurred, have been answered to my satisfaction.


It is strongly recommended that you consult with your physician before beginning any exercise program. Kristi Barker is not a licensed medical doctor and represents that she has no expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific exercise on a medical condition. This preventive program entered into is properly categorized as alternative therapy and DOES NOT qualify as physical therapy. When participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, and are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and forever discharge Kristi Barker and Reach Rehab from any and all claims or causes of action, known or unknown, in relation to or arising from the preventative program.


I hereby grant permission to Kristi Barker and Reach Rehab to take and use photographs and/or digital images of me for use in promotional advertisements. These materials may include printed or electronic publications, websites or other electronic communications. I authorize the use of these images without compensation to me.