Are you taking any medications or supplements?
If so, please list and reason:
Physician’s Phone Number:
Have you had any previous medical condition or surgeries that we should be aware of?
If the answer is yes, please provide details below:
Are you currently seeing a medical professional for any reason?
If the answer is yes, please provide the reason(s) below:
Please list preferred day(s) and time(s) to schedule 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 (collectively, the “Activities”). The provision of the Activities by FOR to you, and your use of any premises, facilities or equipment are contingent upon this agreement.
ASSUMPTION OF RISK: 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 agree that if I engage in any physical exercise or activity, including the Activities, or enter FOR’s premises or use any facility or equipment on FOR’s premises for any purpose, I do so at my own risk and assume the risk of any and all injury and/or damage I may suffer, whether while engaging in physical exercise or not. This includes injury or damage sustained while and/or resulting from using any premises or facility, or using any equipment, whether provided to me by FOR or otherwise, including injuries or damages arising out of the negligence of FOR, whether active or passive, or any of FOR’s employees, agents, representatives, successors and assigns. My assumption of risk includes, but is not limited to, my use of any exercise equipment (mechanical or otherwise), sports fields, courts, or other areas, locker rooms, sidewalks, parking lots, stairs, lobby or other general areas of any facilities, or any equipment. I assume the risk of my participation in all Activities, including but not limited to weightlifting, walking, jogging, running, aerobic or any other sporting or recreational activity. I agree that I am voluntarily participating in the aforementioned activities and assume all risks of injury, illness, death, paralysis, damage, or loss to me or my property that might result, including, without limitation, any loss or theft of any personal property, whether arising out of the negligence of FOR or otherwise. This release is not intended as an attempted release of claims of gross negligence or intentional acts.
RELEASE: As consideration for the right to participate in the Activities, I agree on behalf of myself (and all my personal representatives, heirs, executors, administrators, agents, and assigns) to release and discharge FOR (and FOR’s principals, owners, employees, agents, representatives, successors and assigns) from any and all claims or causes of action (known or unknown) arising out of the negligence of FOR, whether active or passive, or any of FOR’s employees, agents, representatives, successors and assigns. This waiver and release of liability includes, without limitation, any physical or psychological injuries which may occur as a result of (a) my use of any exercise equipment or facilities which may malfunction or break, (b) improper maintenance of any exercise equipment, premises or facilities, (c) negligent instruction or supervision, including personal training, (d) negligent hiring or retention of employees or agents, and/or (e) slipping or tripping and falling while on any portion of a premises or while traveling to or from Activities, including injuries resulting from FOR’s or anyone else’s negligent inspection or maintenance of the facility or premises.
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, its principals, owners, employees, agents, representatives, successors and assigns from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or related to any such activity.
I also acknowledge and agree that:
- All forms of exercise are stressful to the body.
- I am physically and mentally sound and except as may be disclosed on my Health History, suffering from no condition, impairment, disease, infirmity or other illness that prevents my participation in the Activities. If I know or suspect that I have an injury or health condition, now or in the future, it is my responsibility to seek qualified medical supervision and clearance before participating in any Activities and to inform FOR in writing.
- If any Activities cause pain and/or swelling, I will discontinue the Activity immediately and understand that I should consult a physician for diagnosis and treatment.
- If I notice damaged equipment and/or facilities, I will immediately notify a trainer/instructor.
If Activities are conducted at my home, they are at my request. I will provide the workout equipment (“Home Equipment”). I will control the workout area and warrant that all Home Equipment provided is for personal use only. I understand that FOR will not inspect my equipment and does not know its condition. I take sole responsibility for the use of all Home Equipment and understand that equipment may malfunction, and injuries may result. I take sole responsibility to inspect all Home Equipment I take sole responsibility for any injuries incurred by FOR by using the Home Equipment.
This Waiver, Release, and Assumption of Risk (the “Agreement”) 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 the Activities. I agree that if any portion of this Agreement is deemed by a court of competent jurisdiction to be invalid or unenforceable, then the remainder of this Agreement shall remain in full force and effect and the offending provision or provisions severed herefrom. No modification of this Agreement shall be effective unless it is in writing and signed by both me and FOR.
In clicking the 'Agree' button, I acknowledge that I have carefully read this Agreement and fully understand that it is a release of liability, express assumption of risk and indemnity agreement. I am aware and agree that by clicking the ‘Agree’ button, I am giving up my right to bring a legal action or assert a claim against FOR or any of its principals, owners, employees, agents, representatives, successors and assigns for such party’s negligence, or for any defective product used while participating in Activities. I have read and voluntarily signed the Agreement and further agree that no oral representations, statements or inducement apart from the foregoing written agreement have been made. *I Agree