I, {clientName}, hereby acknowledge that the information I've given above is complete and accurate. I understand that the information collected by Mallory Miller Fitness will be used for fitness evaluation purposess and for the design, implementation, progression, and maintenance of an individualized fitness program only.
I further understand that all such information is confidential and will not be shared with anyone without my prior written authorization, except in the case of a medical emergency or to the minimum extent necessary to achieve a safe and effective
fitness program.
By signing this form, I give my consent to participate in the physical fitness evaluation and training program conducted by Mallory Miller Fitness.
BENEFITS
Participation in a regular program of physical activity has been shown to produce positive changes in a number of organ systems. These changes include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power and endurance.
RISKS
I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack). I hereby certify that I know of no medical problem (except those noted in this form) that would increase my risk of illness and injury as a result of participation in a regular exercise program.
TESTING AND EVALUATION RESULTS
I understand that I may undergo initial testing to determine my current physical fitness status. The testing will consist of completing this health inventory, taking a step test or bicycle ergometer test for cardiovascular fitness, and being tested for muscular fitness and body composition. I further understand that such screening is intended to provide Mallory Miller Fitness with essential information used in the development of individual fitness programs. I understand that my individual results will be made available only to me. I also understand that the testing is not intended to replace any other medical test or the services of my physician. I will be provided a copy of all test results. I may share the results with whomever I please, including my personal physician.
RELEASE
By signing this consent form I understand that I am personally responsible for my actions during my tenure at/with Mallory Miller Fitness , and that I waive the responsibility of Mallory Miller Fitness if I should incur any injury as a result of my negligence.