Liability Waiver- Training by Tatum, LLC

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Tatum K. Perez
Certified Fitness & Nutritional Coach

Waiver and Release:
I, as a client, acknowledge that I understand and know about the inherent risks of personal training. I understand and am aware that participation in physical fitness activities, even when completed properly, can be dangerous. I agree to follow the verbal instructions issued by my certified personal trainer. I am aware that potential risks associated with one-on-one training sessions and group training sessions include, but are not limited to, heart attack, stroke, disorders in heartbeat, fainting, death, bodily injury, serious neck and spinal injuries that may result in complete or partial paralysis or brain damages, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal systems and other serious injury or impairment to other aspects of my body, general health and well being. Understanding that injuries are possible, I hereby voluntarily assume ALL risks of injury that could occur by my participation in this personal training program.

I understand that I am responsible for my own medical insurance throughout the entire term of my one-on-one training sessions or group sessions with TXT-training by tatum, LLC. I will assume any additional expenses from injury in a one-on-one training session or group training session that go beyond my health coverage. Additionally, I will notify my certified personal trainer and staff of TXT-training by tatum, LLC of any significant injury that requires medical attention (such as emergency care, hospitalization, etc.)

I expressly assume and accept sole responsibility for my safety and for any and all injuries that may occur from training sessions with TXT training by tatum, LLC. In consideration of the acceptance of this agreement for personal training services, I, and my administrators, executors, successors, and assigns, waive and release any and all claims against Tatum K. Perez, certified personal trainer, individually, or training by tatum, LLC, and their respective staff or agent, and agree, to hold each harmless from any claims or losses, including but limited to, claims for negligence for any injuries or expenses that I may incur while exercising or while traveling to and from training sessions. These exculpatory clauses are intended to apply to any and all activities occurring during the time for which I have contracted with TXT training by tatum, LLC.

Telephone: 317-698-0180 Email: tatum@trainingxtatum.com Website: trainingxtatum.com

Email *

By agreeing/signing below, I, as a client acknowledge that I read and agree to this entire agreement and to each and every term and condition as it applies to my training program *

Agreed

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Participant(s) Full Name *

Telephone Number: Home and Cell (please add dashes) *

Age *

Birthday *

YYYY

What is your occupation? *

On a scale of 0 to 10, do you consider your overall diet to be healthy? *

Low Health

High Health

Are you currently following any kind of diet? If so, what diet and for what reason (s)? *

Do you have any chronic health conditions (such as, but not limited to cardiovascular disease, pulmonary disorders, hypertension, diabetes, or cancer)? (If YES, please explain) *

Are you on any medications, and if so, have you received clearance from your doctor to take part in physical activity? *

Please list out any past surgeries: *

If you have experienced injuries or surgeries, were they properly rehabilitated and did you receive clearance from a doctor to return to physical activity? *

yes

Emergency Contact Name & Phone Number *

Emergency Contact Relationship *

Family Doctor's Name *

Family Doctor's Telephone Number *

A copy of your responses will be emailed to the address you provided.

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