Are you taking any medications or supplements?
If so, please list and reason:
Physician’s Phone Number:
Please explain other important information or any 'yes' answers:
Please use the blue highlighted "pencil button" to circle any area(s) where you are experiencing pain or discomfort.
Please list preferred day(s) and time(s) to scheudle your first three sessions at Fitness on the Run.
Waiver, Release and Assumption of Risk
I am voluntarily participating in personal training sessions, programs, workshops, classes, group classes, class series, or other related Fitness on the Run LLC (FOR) sponsored events. In consideration of the trainer's/instructor's/teacher's agreement to instruct/train me, I do here now and forever release and discharge and hereby hold harmless Fitness on the Run, LLC and FOR’s principals, owners, contractors and agents from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or related to my participation in this or any fitness/wellness related program including any injuries resulting therefrom.
I understand that before beginning any new exercise/wellness program I should first consult with my physician. I have been informed of, understand and am aware that any exercise/wellness program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I have also been informed of, understand and am aware that any exercise or fitness activities involve a risk of injury, abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death. I am voluntarily participating in these FOR sponsored activities and using FOR provided equipment with the full knowledge, understanding and appreciation of the risks and dangers involved. I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death.
In any event, I acknowledge and agree that I assume the risk associated with any and all FOR related activities in which I participate.
I understand that I am being instructed for my own personal health, well-being, and benefit. This instruction in no way qualifies or certifies me to train, instruct, or teach others to use any fitness equipment. I further understand that attempting to train, instruct, or teach others could result in injury to another party who may attempt to hold me liable. I hereby expressly forever release, discharge, and agree to hold harmless FOR LLC, it principals, owners, contractors, and agents from any all claims, demands, damages, rights of action or causes of action, present or future, arising out of or related to any such activity.
I acknowledge that:
- All forms of exercise are stressful to the body.
- If I know or suspect that I have an injury or health condition, it is my responsibility to seek qualified medical supervision and clearance before initiating any exercise program.
- If an exercise causes pain and/or swelling, I should discontinue the exercise immediately and consult a qualified medical expert for diagnosis & treatment.
- If I notice damaged equipment and/or facilities, I should immediately notify a trainer/instructor
- Ultimately I am responsible for my own well-being. If in doubt, I should err on the side of caution.
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 FOR or any of its principals, owners, contractors, and agents.
This Waiver, Release, and Assumption of risk supersedes any and all prior agreements that FOR may have entered into with me in relation to the waiver, release, or assumption of risk relating to my participation in FOR LLC personaltraining sessions, programs, workshops, classes, group classes, class series, or other sponsored events. No modification of this Waiver, Release, and Assumption of Risk shall be effective unless it is in writing and signed by both the Client/Participant and FOR.
In clicking the 'Agree' button, I also understand that Fitness on the Run is in no way responsible for the safe-keeping of my personal belongings while I train. *I Agree