Consent Rel Liability waiver
Client Name: ________________________ Last Name______________________
Phone Number: (_____)_______________________
Emergency Contact: Name: ___________________. Last Name______________
Phone Number: (_____)_____________ Relationship: ______________________
I, the undersigned, desire to voluntarily engage in the Bodies of Perfection Health and Exercise program In order to participate at the Bodies of Perfection Health and Exercise program, I verify that I am in good health with no known contraindications to exercise, that I will notify my physician of my participation in this program if needed. I understand that the program includes exercises that are designed to provide benefits and improvements to my physical health and mental well being in the areas of strength, stamina and endurance.
I enter Samuel Priest’s Health and Exercise program with the hope that I can achieve strength enhancements in my activities of daily living. However, I realize that no guarantees of achievement have been made. I understand that I am responsible for monitoring my own condition along with the trainer throughout the fitness test and the exercise program. If I should have any unusual symptoms such as; extreme shortness of breathe, not related to regular training fatigue/breathing, or unusual chest pain occur I should STOP exercising immediately and notify the trainer or program director and follow-up with my doctor.
This program is designed to enhance my overall strength and all reasonable precautions will be made to protect my health. In some cases to insure the physical safety of the participant, the fitness trainer may require a physician’s release prior to my participation in the Bodies of Perfection Health and Exercise program.
In consideration of being allowed to participate in the Bodies of Perfection/Samuel Priest’s Health and Exercise program, I agree to assume the risk of such exercise and further agree to hold harmless Bodies of perfection and/or Samuel Priest, its staff, collaborator and partners conducting this exercise program from any medical and/or legal liability or responsibility that may arise, and all claims, suits, losses or related causes of action for damages, including, but not limited, to such claims that may result from my injury or death, accidental or otherwise, during or arising in any way from this exercise program.
I have read and understand all of the information in this release form. Any questions that may have occurred to me, regarding the Bodies of Perfection Health Program, have been answered to my satisfaction. I hereby consent to participate in the Bodies of Perfection/Samuel Priest Health and Exercise program by signing this Informed Consent and Release form in the area indicated below.
Release of Liability/Physician Waiver
RELEASE OF LIABILITY IS REQUIRED FOR ALL PARTICIPANTS
It is recommended that all persons who participate in the Bodies of Perfection/Samuel Priest Health and Exercise program obtain their physician’s permission to participate in this program. Signature below signifies acceptance of all responsibility until we receive your doctor’s release or if you choose to participate in the program without a physician’s approval.
Client’s Self-clearance
I, the undersigned, have been informed of the information in regards for a physician’s approval for participation in the Bodies of Perfection Health and Exercise program. I fully understand the nature of this program. I accept complete responsibility for my health and well-being in the health and fitness program and related testing and understand that no responsibility is assumed by the Bodies of Perfection or Samuel Priest. I warrant that I am physically and mentally well enough to proceed with the Bodies of Perfection Health and Exercise program.
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Participant’s Signature: Date
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SAMUEL G. PRIEST-(TRAINER/LIFE COACH) Date
E-MAIL: bodiesofperfection@gmail.com
WEBSITE: SAMUELPRIEST.COM
STUDIO: (951) 326-5203