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Purpose and Explanation of Service
I understand that the purpose of the exercise program is to develop and maintain cardiorespiratory fitness (heart and lungs), body composition (decrease of body fat in individuals needing to lose fat, with an increase in weight of muscle and bone), flexibility, muscular strength and endurance. All exercise prescription components will comply with proper exercise program protocols. The programs include, but are not limited to, aerobic exercise (such as running, walking, and jumping), flexibility training and strength training. All programs are designed to place a gradually increasing workload on the body in order to improve over all fitness.
 I understand, and have been informed, that there exists the possibility of adverse changes when engaging in a physical activity program. I have been informed that these changes could include abnormal blood pressure, fainting, disorders of heart rhythm, stroke and very rare instances of heart attack or even death. I have been told that use of the 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 followed. I have been told that every effort will be made to minimize these occurrences by proper screening and by precautions and observations taken during the exercise session. I understand that there is a risk of injury, heart attack, or even death as a result of my participation in an exercise program, but knowing those risks, it is my desire to partake in the recommended activities. I understand that my instructor or the fitness studio, fitness by the lake, shall not be liable for any damages arising from personal injuries sustained by myself while and during the exercise program. I agree to use exercising equipment during the personal training program and/or exercise classes at my own risk. I assume full responsibility for any injuries or damages which may occur during the training.I understand, when participating in outdoor fitness activities, the risk of injury increases. I have been advised to watch for branches, rocks or anything that may cause me to stumble or lose my balance.  I have been made aware that although the outdoor locations are maintained, to ensure my area is free of debris. I understand the outdoor conditions, such as bugs, are unavoidable and know the risk of bites and stings.


I understand that participation in an exercise program has many health related benefits. These may include improvements in body composition (decrease of body fat in individuals needing to lose fat, with an increase in weight of muscle and bone), range of motion, musculoskeletal strength and endurance, and cardiorespiratory efficiency (heart and lungs). Furthermore, regular exercise can improve blood pressure and lipid profile, metabolic function, and decrease the risk of cardiovascular disease.

Physiological Experience

I have been informed that during my participation in the exercise program I will be asked to complete physical activities that may elicit physiological responses/symptoms that include, but are not limited to the following: elevated heart rate, elevated blood pressure, sweating, fatigue, increased respiration, muscle soreness, cramping, and nausea.

Confidentiality and Use of Information

I have been informed that the information obtained in this exercise program will be treated as privileged and confidential and will consequently not be released or revealed to any person without my express written consent. Any other information obtained, however, will be used only by the program staff to evaluate my exercise status as needed.

Inquiries and Freedom of Consent

I have been given an opportunity to ask questions about the exercise program. I further understand that there are also other remote health risks. Despite the fact that a complete accounting of all these remote risks has not been provided to me, I still desire to proceed with the exercise program.

I acknowledge that I have read this document in its entirety or that it has been read to me if I was unable to read. I consent to the rendition of all services and procedures as explained herein by all program personnel.

I understand and warrant, release and agree that I am in good physical condition and that I have no 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 if I engage or participate ( other than those items fully discussed on health history form).

I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of these classes. Those under 18 years of age must have this form signed by a parent or guardian.