Mary Fulton Fit Liability Waiver/Informed Consent Form
“I, _____________________________, am knowingly and voluntarily participating in an exercise program offered through Mary Fulton Fit. I acknowledge that the program may involve strenuous physical activity including, but not limited to, muscle strengthening and endurance training, cardiovascular conditioning and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this program or have been cleared by a medical professional prior to participating in the program. My enrollment and subsequent participation is purely voluntary and in no way mandated by Mary Fulton Fit.”
“I fully understand that I may injure myself as a result of my subsequent participation in this program and I, _________________________________________, hereby release Mary Fulton Fit, and any or all of its employees, from any liability now, or in the future, for any and all conditions that may arise, directly or indirectly, as a result of my participation in the program. This includes, but is not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, knee injury, back injury, foot injury, other illness, soreness, or death.”
I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.
______________________________________________________(Participant Name)
______________________________________________________(Participant Signature)
______________________________________________________(Minor Child’s Name)
______________________________________________________(Guardian signing for Minor Child)
________________ (Minor Child’s Age) _____________________(Date)
__________________________________________(email address)