Are you medically cleared for strenuous exercise? Yes No
Do you have any medical restrictions on physical activity? Yes No
Waiver, Release, and Assumption of Risk Form
This form is an important legal document. It explains the risks you are assuming by beginning an exercise program. It is critical that you read and understand it completely. After you have done so, please print your name legibly and sign in the spaces provided at the bottom.
Waiver, Informed Consent, and Covenant Not to Sue
I, , have volunteered to participate in a program of physical exercise under the direction of TCBOOST which will include, but may not be limited to, speed and/or resistance training. In consideration of TCBOOST’s agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmlessTCBOOST and their 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 THAT MAY MALFUNCTION OR BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT AND (3) OUR NEGLIGENT INSTRUCTION OR SUPERVISION.
Assumption of Risk
I, , recognize that exercise might be difficult and strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat; heart attack; and in rare instances, death. I understand that as a result of my participation in an exercise program, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I recognize that an examination by my physician must be obtained prior to involvement in this exercise program. I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand that results are individual and may vary. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE 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 TCBOOST FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS
Please print name:
As part of our program, we often videotape training sessions to help us in communicating technique and allow the clients to see how they are doing. From time to time, we put together some of those clips to be able to showcase the kind of training we do at TCBOOST. Do you give permission to TCBOOST to use you or your child’s name, picture, statement, or video footage for the purpose of informing, promoting, or advertising the work that we do at TCBOOST?