Informed Consent Release & Waiver Liability Form

Disclaimer: You should always consult with your doctor before beginning any type of exercise or physical liability.

This form is an important legal document. It explains the risks your child is assuming by beginning an exercise program. It is critical you read and understand it completely. After you have done so, please print the child’s name legibly and sign on their behalf in the space provided at the bottom.

 

Waiver, Informed consent, and covenant not to sue

I have volunteered my child to participate in a class, course or program containing physical exercise under the direction of PeteMooreFitness but may not be limited to weight/or resistance training. In consideration of PeteMooreFitness agreement to instruct, assist, and train my child, I do here release and

discharge and hereby hold harmless PeteMooreFitness and their respective agents, heirs, assigns, contractors and employees from any and all claims, demands, damages, rights or causes of action, present and future, arising out of or connected with my child’s participation in this or any program including any injuries resulting from them. This waiver and release from liability includes, without limitation, injuries which may occur as a result of (1) my child’s use of all amenities and equipment

supplied by PeteMooreFitness, and facilities or premises used for my child’s participation in any activity, class program, personal training or instruction ; (2) equipment that may malfunction or break ; (3) their negligent instruction or supervision ; (4) any slipping and/or falling, or dropping of equipment while under instruction of PeteMooreFitness.

 

 

 

Assumption of Risk

To my best knowledge my child is in good physical condition and has no disease, physical limitation, health concern or injury that would be aggravated or would be the cause of any injury sustained before, during or as a result of my child participating in activities related either directly and/or indirectly to PeteMooreFitness.

I recognise that exercise might be difficult and strenuous and there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise 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 child’s participation in an exercise or other program, my child could suffer an injury or physical disorder that could result in my child becoming partially or totally disabled and incapable of performing any gainful future employment or having a normal social life.

I recognise that an examination by a physician should be obtained for my child prior to involvement in any exercise or physical program. If I have chosen not to obtain a physician’s permission for my child prior to them beginning this exercise or physical program with PeteMooreFitness, I hereby agree that I

am doing so at my child’s 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 my child participates.

I acknowledge and agree that no warranties or representations have been made to my child regarding the results my child will achieve from this program. I understand that results are individual and may vary.

I acknowledge that I have thoroughly read this waiver and release and fully understand that it is a release of liability. By signing this document, I am waiving any right my child or their successors

might have to bring a legal action or assert a claim against PeteMooreFitness, for your negligence or that of your employees, agents, or contractors.

 

Participants name:

___________________________________________________________

Date:

______________________

Participants date of birth:

 

Signature of parent/guardian, individually and in the capacity as parent/guardian, is required for any participant under 18 years of age.

Signing below also confirms that you give approval for first aid to be administered in your absence in the unlikely event that the need should arise. Failure to do so would mean we would be unable to accept your child on any of our sessions.

Parent/guardian name:

________________________________________________________

Parent/guardian signature: ___________________________________________________