INFORMED CONSENT
Client Name __________________________________
Phone _________________ Email _______________________
Please read carefully and sign below.
I, fully understanding that the programs and exercises of any fitness program require moderate physical activity, hereby represent and acknowledge that my physical condition permits me to participate in the program and exercises. I further acknowledge that I have been advised that at any time I am having physical difficulty, I will immediately inform the Practitioner. I have volunteered to participate in this program and accept the responsibility. I understand that the possibility of exercise injuries or disorders does exist. I acknowledge and accept those risks.
I further realize that I will not be accepted for participation in the program if Practitioner knows of any reason why my participation would be dangerous to my health.
I also release and discharge on behalf of myself, my heirs, assigns and successor in interest, all officers, directors, agents, and employees and other representatives of Aquatic Zen and its insurers, from any and all claim, damages, demands, and liabilities arising out of or in any way related to participation in this fitness program activities and the use of any of its exercises, procedures or other results attained therefrom.
______________________________ _____________
Participant’s signature Date
Phone _________________ Email _______________________
Please read carefully and sign below.
I, fully understanding that the programs and exercises of any fitness program require moderate physical activity, hereby represent and acknowledge that my physical condition permits me to participate in the program and exercises. I further acknowledge that I have been advised that at any time I am having physical difficulty, I will immediately inform the Practitioner. I have volunteered to participate in this program and accept the responsibility. I understand that the possibility of exercise injuries or disorders does exist. I acknowledge and accept those risks.
I further realize that I will not be accepted for participation in the program if Practitioner knows of any reason why my participation would be dangerous to my health.
I also release and discharge on behalf of myself, my heirs, assigns and successor in interest, all officers, directors, agents, and employees and other representatives of Aquatic Zen and its insurers, from any and all claim, damages, demands, and liabilities arising out of or in any way related to participation in this fitness program activities and the use of any of its exercises, procedures or other results attained therefrom.
______________________________ _____________
Participant’s signature Date
