JUST TRAIN FOR Jason Theriault Personal Training
Informed Consent Waiver, Release, and Assumption of Risk Form
I have volunteered to participate in a fitness program provided to me by Jason Theriault ("Trainer"), which may include, but may not be limited to, resistance training, aerobic or cardiovascular exercise and/or nutrition counselling, advice and guidance. In consideration of Trainer’s agreement to instruct, I do here now and forever release and discharge and hereby hold harmless Jason Theriault ("Trainer"), and his respective agents, heirs, assigns, contractors, and 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 and/or nutrition program including any injuries resulting there from.
THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT BELONGING TO TRAINER OR TO MYSELF THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION.
I have been informed of, understand and am aware that any exercise/wellness program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death.
I have been advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed or diet. If I have chosen not to obtain a physician’s consent prior to beginning this fitness program with Trainer, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all fitness and wellness related activities and/or exercises in which I participate.
I confirm that I am at least the age of majority in your state or province of residence.
The nutrition advice given by Jason Theriault, is based on the information provided by myself. I understand that the nutrition information given is meant only for myself. Any misinformation or omitted information may affect the nutritional assessment and guidance. Any misrepresented information is solely of my responsibility and Jason Theriault, will not be liable. I acknowledged that Jason Theriault, provides nutrition consulting and recommendations only and is not a certified dietician or physician and is not licensed to diagnose a medical condition or illness. I must consult a physician for any medical advice.
I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY 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 TRAINER FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS.
This form is an important legal document that explains the risks you are assuming by beginning an exercise and/or fitness program. It is critical that you have read and understand this document completely. If you do not understand any part of this document, it is your ultimate responsibility to ask for clarification prior to signing it.