I hereby consent to voluntarily engage in an acceptable plan of personal fitness training. I also give consent to be placed in personal fitness training program activities which are recommended to me for improvement of dietary counseling, stress management, and health/fitness education activities. The levels of exercise I perform will be based upon my cardiorespiratory (heart and lungs) and muscular fitness. I understand that I may be required to undergo a graded exercise test prior to the start of my personal fitness training program in order to evaluate and assess my present level of fitness.
My personal trainer has explained that no exercise program is without inherent risks and that, regardless of the care taken by my personal trainer, he (or she) cannot guarantee my personal safety. For example, when one induces cardiovascular stress through activity, injuries can range from occasional minor injury (e.g. pulled muscles, muscle soreness) to infrequent serious injury (e.g. heart attack, stroke, or other cardiovascular accidents) to the very rare catastrophic incident (e.g. death, paralysis). Likewise, I know that engaging in muscular endurance, strength building, and other fitness activities occasionally results in minor injuries (e.g. bruises, musculo-skeletal strains and sprains), infrequently, more serious injuries (e.g. muscle tears, herniated disks, torn rotator cuffs), and very rarely, catastrophic injury (e.g. death, paralysis). I realize that when participating in any exercises or conditioning activity, there is always a possibility that minor injuries, major injuries, or catastrophic injury/death may occur.
I understand that a regular exercise program has been shown to have definite benefits to general health and well-being. I know that some of the physiological benefits of a regular exercise program can include loss of weight, reduction of body fat, improvement of blood lipids, lowering of blood pressure, improvement in cardiovascular function, reduction in risk of heart disease, improved strength and muscular endurance, improved posture, and improved flexibility. I further understand that regular exercise can have psychological benefits, often improving one’s outlook as well as relieving tension and stress.
I have been informed that the information which is obtained in this personal fitness training program will be treated as privileged and confidential and will consequently not be released or revealed to any person, to the use of any information which is not personally identifiable with me for research and statistical purposes so long as same does not identify my person or provide facts which could lead to my identification. Any other information obtained, however, will be used only by the program staff to evaluate my exercise status or needs.
I understand that it is my responsibility to: 1) Cancel a scheduled session at least 24 hours prior to the scheduled appointment. If I fail to do this, I will forfeit the session without a refund. At the trainers’ discretion, certain instances will be considered for exclusion in the case that they are unavoidable emergencies and that particular session is rescheduled in a timely fashion suited to the trainers’ availability. Trainer availability for rescheduling is not guaranteed. 2) Take seriously and attend all scheduled training appointments. To the best of my ability I will comply with all of the program components in an effort to assist in the achievement of my goals. 3) Inform the trainer if there are any activities with which I do not feel comfortable. 4) Cease exercise and report promptly any unusual feelings (e.g. chest discomfort, nausea, difficulty breathing, apparent injury) during the exercise program.
In agreeing to this exercise program, I, the client:
Acknowledge that my participation is voluntary.
Understand the potential risks involved in the exercise program and believe that the potential benefits outweigh those risks.
Give consent to certain physical touching that may be necessary to ensure proper technique and body alignment.
Understand that the achievement of health or fitness goals cannot be guaranteed.
Have had a voice in planning and approving the activities selected for my exercise program.
Have been able to ask questions regarding any concerns I might have, and have had those questions answered to my satisfaction.
Am in good physical condition, have no impairment that might prevent my participation in such activities, and have been advised to consult a physician prior to beginning this program.
Have been advised to cease exercise immediately if I experience unusual discomfort and feel the need to stop.
By submitting your electronic signature via the Client Intake Questionnaire means you acknowledge, agree and have read the terms on this site.