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 Fit vdS, which will include, but may not be limited to, weight and/or resistance training. In
consideration of Fit vdS agreement to instruct, assist and train me, I do here and forever release and discharge and
hereby hold harmless Fit vdS and their 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; AND (2) ANY SLIP, FALL DROPPING OF EQUIPMENT (3) ANY INJURY THAT
MAY OCCUR AS A RESULT OF EXERCISING OUTDOORS INCLUDING CAR ACCIDENT AND INJURIES
RELATED TO GLASS OR OTHER DEBRIS ON EXERCISE SURFACES.
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 recognized that an examination by a physician should be obtained by all participants prior to involvement in any
exercise program. If I, , have chosen not to obtain a physician’s permission prior to
beginning this exercise program with Fit vdS, I hereby agree that I am doing so at my own risk.
In any event, 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 representation 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 THOUROGHLY 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 Fit vdS FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES.