General Statement of Program Objectives and Procedures:
I understand that this physical fitness/exercise program includes exercises to build the
cardiorespiratory system (heart and lungs), the musculoskeletal system (muscle endurance and
strength, and flexibility) and/or to improve body composition (decrease of body fat in individuals
needing to lose fat, with an increase in weight of muscle and bone). Exercise may include aerobic
activities to improve and maintain cardiovascular endurance (treadmill, walking, running, bicycle
riding, rowing machine exercises, group aerobic activity, swimming and other aerobic activities),
calisthenics exercises, and weight lifting to improve and maintain muscular strength and
endurance, and flexibility exercises to improve and maintain joint range of motion.
Description of Potential Risks:
- I understand that the reaction of the heart, lung, and blood vessel system to exercise cannot
always be predicted with accuracy.
- I know there is a risk of certain abnormal changes occurring during or following exercise which
may include abnormalities of blood pressure or heart attacks.
- I understand that use of the weight lifting equipment and engaging in heavy body calisthenics
may lead to musculoskeletal strains, pain and injury if safety procedures are not followed.
- I understand that the Personal Trainer/Therapist and the Injury Rehab Centre shall not be liable
for any damages arising from personal injuries sustained by the client while and during the
personal training/exercise program.
- Client using the exercising equipment during the personal training program does so at his/her
- Client assumes full responsibility for any injuries or damages which may occur during the
- I hereby fully and forever release and discharge the Injury Rehab Centre, its assigns and agents
from all claims, demands, damages, rights of action, present and future therein.
- I understand and warrant, release and agree that I am in good physical condition and that I have
no disability, impairment or ailment preventing me from engaging in active or passive exercise
that will be detrimental to safety, comfort, or physical condition if I engage or \ participate (other
than those items fully discussed on health history form).
- I state that I have had a recent physical examination and have my personal doctor’s permission
to engage in aerobic and/or anaerobic conditioning.