(SIS Personal Information & Waiver)

Gender *

Sistas In Shape

Informed Consent Waiver/Release and Hold Harmless Agreement for Participant

 

I, the undersigned participant, am hereby participating in a program of strenuous physically 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 prior to starting an exercise program or increasing the intensity of an existing program, 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 prior to 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.

 

In the event that 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 effect 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 decided 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 UPS fitness program and I hereby release SIS, its Board, and 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 SIS fitness program, I for myself, my personal representatives, administrators, heirs and assigns, hereby holds harmless SIS, 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 the SIS permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all 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 by reason 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 given the opportunity to present questions in all related matters.

 

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