911 Physical Training

Liability Waiver

I, (print name) _______________________________________ , give my consent to participate in the physical fitness evaluation program conducted by 911 PHYSICAL TRAINING.
BENEFITS
Participation in a regular program of physical activity has been shown to produce positive changes in a number of organ systems. These changes include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power and endurance.
RISKS
I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack). I hereby certify that I know of no medical problem (except those noted below) that would increase my risk of illness and injury as a result of participation in a regular exercise program.
TESTING AND EVALUATION RESULTS
I understand that I will undergo initial testing to determine my current physical fitness status. The testing will consist of completing this health inventory, taking a step test or bicycle ergometer test for cardiovascular fitness, and being tested for muscular fitness and body composition.
I further understand that such screening is intended to provide 911 Physical Training/Dawn W. Hendricks
with essential information used in the development of individual fitness programs. I understand that my individual results will be made available only to me. I also understand that the testing is not intended to replace any other medical test or the services of my physician. I will be provided a copy of all test results. I may share the results with whomever I please, including my personal physician. By signing this consent form I understand that I am personally responsible for my actions during my tenure at ANY 911 Physical Training Locations , and that I waive the responsibility of this center if I should incur any injury as a result of my negligence.
NAME:______________________SIGNATURE:_______________________DATE:________

PARENT/GUARDIAN Signature:___________________________WITNESS:____________________

InformedConsent_0805