(Personal Information & Waiver)

Gender *

Patriots In Shape

Informed Consent Waiver/Release and Hold Harmless Agreement for Participant


I, the undersigned participant, am hereby participating in a program of strenuous physical activity including, but not limited to weightlifting, and various other aerobic conditioning programs offered by Sistas In Shape(SIS). I have been strongly encouraged to consult with my physician before starting an exercise program or increasing the intensity of an existing program, as indicated both in this document and by SIS. I assume the responsibility as indicated by my below signature and if I choose to, will act on this advice before the implementation of any recommendations made by SIS. I hereby affirm that, to the best of my knowledge, I do not suffer from any condition that would prevent or limit my participation in this fitness program and have not withheld any related information from SIS.


If through screening, I have been determined to be other than apparently healthy, I will be required to obtain a release from my physician to resume any physical activities, as required by SIS. I'm taking no medications that may adversely affect my fitness activities, and this release, with or without physician’s restrictions, has been given to SIS. In addition, I acknowledge that if my health changes, it is my responsibility to recognize the change and seek medical advice to help me decide if my continued participation in the fitness program or any part of the fitness program is still right for me.


I fully understand that I may injure myself as a result of my participation In Shape fitness program and I hereby release SIS, its Board, and its employees from any liability now or in the future for any injury. Injuries may include but are not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries, and any other illness, soreness, or injury, however, caused, occurring during, or after, my participation in the fitness program offered, unless caused by the trainer’s recklessness or intentional misconduct.


In consideration of my participation in In Shape fitness program, I for myself, my personal representatives, administrators, heirs, and assigns, hereby hold harmless In Shape, its Board, and employees from any claims, demands, and causes of action, to include reasonable legal expenses and attorney’s fees arising from my participation in the fitness program, unless caused by the trainer’s recklessness or intentional misconduct.


I hereby grant In Shape permission to use my likeness in a photograph, video, or other digital media (“photo”) in any of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of the SIS and will not be returned.

I hereby hold harmless, release, and forever discharge the SIS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have because of this authorization.


I hereby affirm that I have read, have been honest with Sistas In Shape(SIS), and fully understand the above information. I have been allowed to present questions in all related matters.


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