► Informed Consent

PLEASE FILL OUT ALL INFORMATION REQUESTED BELOW

, give my consent to participate in the physical fit-ness evaluation program conducted by Name of Business

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.

I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardiorespirato-ry system (dizziness, discomfort in breathing, heart attack). I hereby certify that I know of no medical problem (except those noted below) that would increase my risk of illness and injury as a result of participation in a regular exercise program.

I understand that I will undergo initial testing to determine my current physical fitness status. The testing will con-sist 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 Name of Business with essential information used in the development of individual fitness programs. I understand that my individ-ual 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. By signing this consent form I understand that I am person-ally responsible for my actions during my tenure at Name of Business , and that I waive the responsibility of this center if I should incur any injury as a result of my negligence.