INFORMED CONSENT FOR EXERCISE PARTICIPATION
I desire to engage voluntarily in an exercise program given by: Hartbeat in Motion- Muevete in collaboration with the City of Hartford. I understand that the activities are designed to place a gradually increasing workload on the body in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workouts and should any unusual symptoms occur, I will cease my participation and inform the staff of the symptoms and/or any apparent injuries or discomforts that I may sustain.
In signing this consent form, I affirm that I have read, accept, and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with fitness classes and willingly accept those risks and/or possibilities. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities. I agree to pay all reasonable costs related to the classes, including, but not limited to, any medical and/or legal costs I incur.
AGREEMENT AND WAIVER / RELEASE OF LIABILITY
In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns to:
- Waive, release and discharge Hartbeat in Motion- Muevete and the City of Hartford, their respective elected and appointed officials, officers, employees, students, agents, and volunteers, for my death, disability, personal injury, property damage, losses, expenses, or property theft, or actions of any kind which may hereafter accrue to me, all of the foregoing being directly of indirectly related to the exercise program described herein.
- Indemnify and hold harmless, Hartbeat in Motion- Muevete and the City of Hartford, their respective elected and appointed officials, officers, employees, students, agents, and volunteers, from and against any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation in this activity.
By signing this document, I hereby give my consent that my name, portrait, voice, picture or electronic image of any kind, may be used by Hartbeat in Motion- Muevete and the City of Harftord, their respective clients, customers, agents, licensees or successors and assigns, and I hereby grant to them free and unlimited right to publish, for any and all news, trades, publicity, commercial or noncommercial photographic prints, video, audio or digital images of me and any reproductions thereof, or parts thereof, photographic or otherwise with such additions, alterations or changes therein as Hartbeat in Motion- Muevete or the City of Hartford, may in their discretion or in the discretion of any of them, make or authorize, and to use, sell, distribute, publish, and republish the same, either separately or together with my name or fictitious name.
Therefore, intending to be bound and as a condition of being allowed to participate in the fitness class, I have freely signed this waiver on the date indicated.