Waiver, Release, and Assumption of Risk Form

I,                                                            have volunteered to participate in a fitness program provided to

me by                                                  , which may include, but may not be limited to, resistance training and

aerobic or cardiovascular exercise. In consideration of Trainer’s agreement to instruct and train me, I do here now

and forever release and discharge and hereby hold harmless Trainer and his 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 this or any exercise program including any

injuries resulting there from. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES

WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT BELONGING TO TRAINER OR TO MYSELF THAT MAY

MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION

OR SUPERVISION. I,                                                              , have been informed of, understand and am

aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially

hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness

activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart

attack, stroke, other serious disability or death, and that I am voluntarily participating in these activities and using

equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby

agree to expressly assume and accept any and all risks of injury, regardless of severity, or death. I have been

advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or

exercise program, or initiating a substantial change in the amount of regular physical activity performed. If I,

                                               , have chosen not to obtain a physician’s consent prior to beginning this fitness

program with Trainer, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and

agree that I assume the risks associated with any and all fitness related activities and/or exercises in which I

participate.

I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND THAT IT IS

A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT

HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST TRAINER FOR YOUR NEGLIGENCE OR THAT OF YOUR

EMPLOYEES, AGENTS, OR CONTRACTORS. 2 This form is an important legal document that explains the risks you are

assuming by beginning an exercise program. It is critical that you have read and understand this document

completely. If you do not understand any part of this document, it is your ultimate responsibility to ask for

clarification prior to signing it.

Participant’s signature                                                                                

 

Please print name

 

Parent or legal guardian  (if participant is under age eighteen)

 

Please print name                                                               

Thanks for submitting!

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