HEALTH/WELLNESS PARTICIPATION AGREEMENT, INFORMED CONSENT, AND RELEASE OF CLAIMS, ASSUMPTION OF RISK AND LIABILITY.
Thank you for choosing ReFit360, LLC DBA FITSPACE as your Health/Wellness Provider. It is our policy to be as accommodating as possible for you, the client, to schedule your sessions. Consistent attendance allows you and your trainer to progress, which will result in moving towards results and outcomes for your goals. In the event that you are unable to make one of your appointments, please contact us in advance. We will help you reschedule your appointment. Health/Wellness sessions may be scheduled during operating hours only. You will be provided a program to carry out at our facility or your own gym. More than three late cancels (within 24 hours) or no shows will, unfortunately, limit your ability to schedule advance appointments; this may result in allowing same day scheduling only. I consent to voluntarily engage in a program of personal fitness training and related. I understand that personal training is not “physical therapy” for medical purposes and my health plan will not cover the cost of the service. I also consent to participate in 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 the representations of 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 Programs in order to evaluate and assess my present level of fitness. I understand that I am expected to attend every session and to follow staff instructions with regard to exercise, stress management, and other health and fitness related programs. If I am taking prescribed medications, I have already so informed the program staff and further agree to so inform them promptly of any changes which my doctor or I have made with regard to use of these medications. I will be given the opportunity for periodic assessment and evaluation at regular intervals after the start of the Programs. I understand that during my participation in the Programs, I will be asked to complete the physical activities unless symptoms such as fatigue, shortness of breath, chest discomfort or similar occurrences appear. At this point, I understand it is my obligation to inform the personal fitness training program personnel of my symptoms, should any develop, and that it is my complete right to decrease or stop exercise. I also understand that during the performance of my personal fitness training program, physical touching and positioning of my body may be necessary to assess my muscular and bodily reactions to specific exercises, as well as to ensure that I am using proper technique and body alignment. I expressly consent to the physical contact for the stated reasons above. I understand that there exists the possibility during exercise of adverse health consequences including, but not limited to, abnormal blood pressure, fainting, dizziness, disorders of heart rhythm, and in very rare instances heart attack, stroke, or even death. I understand that there exists the risk of bodily injury including, but not limited to, injuries to the muscles, ligaments, tendons, and joints of the body. I fully accept and understand the risks associated with exercise, including the risk of bodily injury, heart attack, stroke or even death, but knowing these risks, it is my desire to participate in these Programs. I understand that this program may or may not benefit my physical fitness or general health. I recognize that involvement in the personal fitness training sessions will allow me to learn proper ways to perform conditioning exercises, use fitness equipment and regulate physical effort. These experiences should benefit me by indicating how my physical limitations may affect my ability to perform various physical activities. I further understand that if I closely follow the program instructions, that I will likely improve my exercise capacity and fitness level after a period of 3-6 months. I also understand that results from exercise cannot be, and are not, guaranteed. I have been given an opportunity to ask questions as to the Programs and the risks of participation. I accept such risks and confirm that I consent to participation in the Programs. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in the Programs or else I agree to bear the costs of such injury or damage myself. I have completed the pre-exercise screening form and have truthfully answered all questions to the best of my ability. I am aware that participation could, in some circumstances, result in physical injury or medical complications from underlying health conditions. I declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in any of the Programs. I acknowledge that I have either had a physical examination and have been given a physician’s permission to participate in the Programs or that I have decided to participate in the Programs without the approval of my physician. I do hereby assume all responsibility for all outcomes positive and negative resulting from my participation in Programs. I agree that if any portion of the Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. IN CONSIDERATION OF MY PARTICIPATION IN THE PROGRAMS OFFERED BY FITSPACE, FOR MYSELF, MY HEIRS, EXECUTORS, AND ADMINISTRATORS, I HEREBY WAIVE AND RELEASE ANY CLAIMS FOR INJURY, DAMAGE OR DEATH AND WAIVE ANY AND ALL CLAIMS OF ANY KIND, INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE OWED ON THE PART OF FITSPACE THAT I HAVE OR MAY IN THE FUTURE HAVE AGAINST FITSPACE AND ITS DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES. I HEREBY RELEASE FITSPACE FROM ANY AND ALL LIABILITY FOR ANY LOSS, DAMAGE, INJURY OR EXPENSE THAT I MAY SUFFER AS A RESULT OF PARTICIPATING IN THE PROGRAMS OFFERED BY FITSPACE DUE TO ANY CAUSE WHATSOEVER.
I acknowledge that I have read, understand, and will abide by the above policies.