Drop-in $60 for one week

$60


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Informed Consent form for Physical Fitness Program

 

 
General Statement of Program Objectives and Procedures

 

I understand that this physical fitness program includes exercises to build the cardio-respiratory system (heart and lungs), the musculoskeletal system (muscle endurance and strength, and flexibility), and to improve body composition (decrease of body fat in individuals needing to lose fat, with an increase in weight of muscle and bone). Exercise may include aerobic activities (treadmill, walking, running, bicycle riding, rowing machine exercises, group aerobic activity, swimming and other aerobic activities), calisthenic exercises, and weight lifting to improve muscular strength and endurance and flexibility exercises to improve joint range of motion.


 

Description of Potential Risks

 

I understand that the reaction of the heart, lung, and blood vessel system to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or following exercise, which may include abnormalities of blood pressure or heart attack. 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 understand that the personal trainer ( seller ) shall not be liable for any damages arising from personal injuries sustained by client ( buyer ) while and during the personal training program. Client ( buyer ) using the exercising equipment during the personal training program does so at his/her own risk. Client ( buyer ) assumes full responsibility for any injuries or damages which may occur during the training. I hereby fully and forever release and discharge personal trainer ( seller ), its assigns and agents from all claims, demands, damages, rights of action, present and future therein. 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, comfort, or physical condition. ( other than those items fully discussed on health history form). I state that I have had a recent physical checkup and have my personal physician's permission to engage in aerobic and/or anaerobic conditioning.


 

Description of Potential Benefits

 

 


 

I understand that a program of regular exercise for the heart, lungs, muscles and joints, has many benefits associated with it. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement in physiological function, and decrease in heart disease. I have read the foregoing information and understand it. Any questions which may have occurred to me have been answered to my satisfaction.


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Participant’s signature (parent/guardian if under 18) Date


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Please print name

 

 

 

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 Kings Point Box LLC & CrossFit Inc., which will include, but may not be limited to, weight and/or resistance training. In consideration of Kings Point Box LLC & CrossFit Inc. agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless Kings Point Box LLC & CrossFit Inc. 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 therefrom. 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 Kings Point Box LLC & CrossFit Inc. FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS.

 

 

 

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Participant’s signature (parent/guardian if under 18) Date