Fitness Informed Consent Form

Please read through each and every item in this informed consent and mark each checkbox provided as an affirmation to the understanding of the provisions below. Feel free to ask us questions or raise with us some concerns, any time.

Kenisha Coleman Email: Kenisha@FITwithKQ.com

Phone: 704-608-9232

I understand that in my participation in exercises involved may including, but limited to,various aerobic activities, walking, running, cycling, rowing, and weight lifting with the use of machines.I understand that with my voluntary participation, I may be given a fitness training plan suitable for the improvement of my cardiorespiratory (heart and lungs), musculoskeletal (muscles, joints, and bones), and overall body fitness.

I understand that during the conduct of exercise, the reaction of my heart, lungs, and blood vessels, etc., cannot be predicted with accuracy, thus risks may arise due.I understand that during training, injuries may arise such as muscle, ligaments, joints and tendons; and I have been given proper non-medical instructions in order to prevent or minimize these occurrences.I understand I should consult with my doctor for any questions I may have about my physical ability to train with FITwithKQ, LLC as well as any questions or concerns I may have about injuries.I voluntarily assume the risk of training with FITwithKQ, LLC.

I understand that I shall solely be responsible, and the FITwithKQ, LLC shall not be held liable for any damages and injuries arising from the fitness training program.I understand that during training, injuries may arise such as muscle, ligaments, joints and tendons; and I have been given proper non-medical instructions in order to prevent and/or minimize these occurrences.I hereby release and fully and forever discharge FITwithKQ, LLC its assignees, agents and employees from any and all claims, demands, and/or damages therein.Further I will hold harmless and indemnify FITwithKQ, LLC its assignees, agents and employees from any and all claims, demands, and/or damages therein

I am aware that all information obtained by FITwithKQ, LLC from me, such as fitness records, personal information, among others, shall be treated as confidential. This information shall not be disclosed nor shared to anyone without your prior written consent or if required by law.I understand that the information obtained will be used by FITwithKQ, LLC to evaluate my progress.

By signing this form, I am acknowledging I have read each paragraph and consent to everything contained therein. I understand all the terms, my rights, as well as my obligations herein. I voluntarily give my consent and I declare that I was not induced or coerced into signing this form.

I am of legal age and I am legally competent to give my consent to this agreement.I am below of legal age or I am not competent to sign this agreement. My Parent/Guardian/Representative shall sign this informed consent on my behalf.

Name*

First NameLast Name

Email*

example@example.com

Date*

Date

Signature*

Parent/Guardian/Representative

First NameLast Name

Email

example@example.com

Date

Signature