Informed Consent for Personal Training with

Destination Fitness LLC.

Name:___________________________________

I.                    Fitness Testing

              Fitness testing is optional.

The purpose of the fitness testing program is to evaluate cardiorespiratory fitness, body composition, flexibility, and muscular strength and endurance. The cardiorespiratory fitness test involves a submaximal test that may include a bench step test or one-mile walk test. Flexibility is determined by the sit-and-reach test. Muscular endurance may be determined by a push-up or bent-knee sit-up test.

II.                  Exercise

I desire to engage voluntarily in an exercise program designed by Destination Fitness LLC in order to attempt to improve my physical fitness. I understand that the activities are designed to place a gradually increasing workload on the cardiorespiratory system and thereby attempt to improve its fitness. The reaction of the cardiorespiratory system to such activities cannot be predicted with complete accuracy. There is a risk of certain changes that might occur during or following exercise. These changes might include abnormalities of blood pressure or heart rate.

I understand that the purpose of the exercise program is to develop and maintain cardiorespiratory fitness, by body composition, flexibility and muscular strength and endurance. A specific exercise plan will be given to me, based on my needs and interests and my doctors recommendations. All exercise programs include warm-up, exercise at target heart rate and cool down. The programs may involve walking, jogging, swimming, or cycling; participation in exercise fitness, rhythmic aerobic exercise; or calisthenics or strength training. All programs are designed to place a gradually increased workload on the body tin order to improve overall fitness. The rate of progression is regulated by exercising to a target heart rate and rate of perceived exertion.

I affirm that I am responsible for monitoring my own condition throughout the tests and/or exercise program, and should any unusual symptoms occur, I will cease my participation and inform my instructor on the symptoms.

In signing this consent form, I affirm that I have read this form in its entirety and that I understand the description of the tests and their components. I also affirm that my questions regarding the fitness-testing program have been answered to my satisfaction.

In the event that a medical clearance must be obtained prior to my participation in the fitness-testing program, I agree to consult my physician and obtain written permission from my physician prior to beginning any fitness testing.

Also, in consideration for being allowed to participate in the fitness training and/or exercise program, I agree to assume the risk of such testing or exercise, and further agree to hold harmless Destination Fitness LLC while conducting such testing and/or exercise program from any and all claims, suits, losses, or related causes of action for damages, including, but not limited to, such claims that may result from injury or death, accidental or otherwise, during, or arising in any way from the testing or exercise program.

_________________________________________________                                         ____________

Signature of Participant & Parent if under 18                                                            Date