New Vision Fitness Program Forms

Participant Name*

First NameLast Name
Email (for confirmation email)*
example@example.com
Phone Number*

Area CodePhone Number
New Vision Fitness Program Release & Waiver
In exchange for participation in the activity of exercise and fitness training organized by New Vision for Independence, I agree for myself and (if applicable) for the members of my family, to the following:
1. Agreement to Follow Directions: I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by New Vision for Independence or the employees, representatives or agents of New Vision for Independence.
2. Assumption of The Risks and Release: I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge New Vision for Independence and the employees, representatives or agents of New Vision for Independence for injury, loss or damage arising out of my or my family’s use of or presence upon the facilities of New Vision for Independence, whether caused by fault of myself, my family, New Vision for Independence or other third parties.
3. Indemnification: I agree to indemnify and defend New Vision for Independence and the employees, representatives or agents of New Vision for Independence against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family’s use of or presence upon the facilities or instructions of Lisa Fisher and New Vision for Independence.
4. Applicable Law: Any legal or equitable claim that may arise from participation in the above shall be resolved under Florida law.
5. Enforceability: The invalidity or unenforceability of any provision of this agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be part of the agreement.
I have read this document and understand it. I further understand that by signing this release, I voluntarily surrender certain legal rights.
By typing my name below, I commit my electronic signature.*

First NameLast Name
Date*

MonthDayYear
Date

New Vision Readiness for Exercise Questionnaire
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
Do you feel pain in your chest when you perform physical activity?*
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?*
Do you know any other reason why you should not engage in physical activity?*
If you have answered yes to any of the questions on this questionnaire, consult with your physician before engaging further in the New Vision for Independence Wellness Program.

After medical evaluation, seek advice form your physician on what type of activity is suitable for your current condition.
I have answered no to all the questions.

First NameLast Name
I have answered yes to one or more of the questions and have consulted with my physician. I understand my medical condition and what physical activity is suitable for my condition.

First NameLast Name
Please provide any information that may be pertinent to your participation in New Vision fitness activities.
Date*

MonthDayYear
Date
Should be Empty:

New Vision Fitness Program Release & Waiver

New Vision Readiness for Exercise Questionnaire