Before signing this form, feel free to ask any questions regarding any aspect of this program that may be unclear to you. Take as much time as necessary to think it over. Please consult your participation with your doctor.
1. EXPLANATION OF THE EXERCISE SESSIONS AND PROGRAMS
I desire to voluntarily participate in one or more Programs (see attached Schedule of Programs) offered through COREEN WOZNIAK’S BALANCED FITNESS, LLC (hereinafter “Balanced Fitness”), or any other classes that may be offered by Balanced Fitness, in order to improve my physical fitness level. The exercise sessions I will become involved in will follow progressive exercise levels conducted by Coreen Wozniak, or one of the other Instructors (see attached List of Instructors).
The sessions will consist of aerobic-type activities (rhythmical exercises which utilize large muscle groups for sustained periods of time). These exercise activities are designed to place a gradually increasing workload on the body and thereby improve its functioning, although no guarantee of improvement can be made. All exercise sessions are indoors, outdoors, virtual and/or prerecorded conducted at Coreen Wozniak’s Balanced Fitness Studio and other onsite locations. During the Program exercise sessions, muscular soreness and fatigue may be experienced.
2. RISK AND DISCOMFORTS OF THE EXERCISE SESSION
The reaction of the cardiovascular system to such activities cannot always be predicted with complete accuracy. Therefore, there is the risk of certain changes occurring during or following the exercises. These changes include, but are not limited to, abnormalities of blood pressure or heart rate and, in rare instances, cardiac complications. A physician will not be present during the exercise Programs offered by Balanced Fitness. Should you observe any discomfort or symptoms, use your commonsense and stop the exercise and immediately report these symptoms to the exercise coordinator.
3. ASSUMPTION OF RISK
I am fully aware that aggressive exercise can be high-risk activity. Participating in these activities could result in falls or other risks that could cause injury. Understanding the risks and dangers of participating in Balanced Fitness Program, I represent that to the best of my knowledge I have no medical, physical and/or emotional health condition which would hinder or prevent my active participation in the Program activities in any way whatsoever.
I also realize the dangerous nature of cardiovascular exercise. I, therefore, fully understand and I am mindful of the serious consequences, which might result, due to my involvement in cardiovascular exercise during any Balanced Fitness Programs. I represent to the best of my knowledge that I am physically sound and have medical approval to proceed with exercise including, but not limited to, any of those exercises and programs listed in paragraph of this release or otherwise identified herein. I shall undertake all exercises at my sole risk. I am in good health and have no physical conditions that would be aggravated by my involvement in cardiovascular exercise nor do I have any physical limitations that would preclude said involvement in any Balanced Fitness Programs in any way whatsoever. I further understand that Coreen Wozniak, any other listed in the attached list of instructors, or any instructor subbing a class not listed & Coreen Wozniak’s Balanced Fitness LLC and/or Coreen Wozniak’s Balanced Fitness Studio and/or other onsite locations (and their contractors) are not medical doctors, and that they are relying upon my representations and disclosures that I am physically able, capable and medically cleared to physically participate in the programs.
Therefore, I assume full responsibility for my participation in any of Coreen Wozniak’s Balanced Fitness programs we offer. I AM FULLY AWARE OF ALL RISKS, DANGERS AND HAZARDS AND I VOLUNTARILY AND FREELY CHOOSE TO ASSUME ALL SUCH RISKS, DANGERS, AND HAZARDS INCLUDING, BUT NOT LIMITED TO, THE RISK OF INJURY OR DEATH THAT MAY BE ASSOCIATED WITH, OR RESULT FROM, MY PARTICIPATION IN THE EXERCISE PROGRAMS. THEREFORE, I ASSUME FULL RESPONSIBILTY FOR MY PARTICIPTION IN ANY OF THE BALANCED FTNESS PROGRAMS.
4. SHARED RESPONSIBILITY FOR SPORT SAFETY: AWARENESS OF RISK
Trainers and clients must share the responsibility for sport and fitness safety. I, the undersigned, am aware and appreciate that there are risks of injury involved in my participation in any fitness-training program. Signing this statement is intended to make me aware of my responsibilities in preventing potential injuries or harm, reporting actual injuries, and complying with the treatment plan of my healthcare providers and indicates that I understand and appreciate the risks involved with my participation in any Balanced Fitness Program. I understand that this includes the risk of brain and spinal cord injury that may result in paralysis, other permanent injury, or possibly death.
Female participants with menstrual irregularities may experience an adverse effect on bone density that may result in osteoporosis (decrease in bone density). I understand and appreciate that the increased risk of stress fractures due to the loss of bone density that results from menstrual irregularities and know that I should seek prompt medical attention if this condition develops or exists, ensuring appropriate preventative measures.
5. PHYSICAL ADJUSTMENT DURING PROGRAMS
I fully agree and understand that from time to time during the guided exercises and program sessions that the instructor may physically adjust and correct participants’ form and posture. If I do not want such physical adjustments and correction, I will so inform the instructor at the beginning of each exercise class I begin, or if attending the entire program, each program I attend. I also acknowledge that if I DO WISH to receive adjustments and correction, that it is my responsibility to inform the instructor immediately when an adjustment or correction has gone as far as I desire each time.
6. RELEASE FROM LIABILITY
I fully agree, for myself and heirs, to hereby fully and forever discharge and release COREEN WOZNIAK’S BALANCED FITNESS LLC , Coreen Wozniak, any Instructor, Coreen Wozniak’s Fitness Studio and any agents of any of the aforementioned; from any and all liability, all claims and demand, actions, causes of action whatsoever arising out of any damages, costs, loss of services, expenses and any and all claims whatsoever, whether caused by its negligence or any other reason, on account of or in any way resulting from personal injuries, conscious suffering, death or property damages to myself or any other person or property, in any way connected with my preparation or practice of or participation in any Balanced Fitness Program, or while traveling to or from Coreen Wozniak’s Balanced Fitness Studio or other onsite locations for participation in the Programs and/or exercises.
7. COVENANT NOT TO SUE
I agree, for myself and my heirs, not to sue, Coreen Wozniak’s Balanced Fitness LLC, Coreen Wozniak, any instructor, Coreen Wozniak’s Balanced Fitness Studio and any agents of the aforementioned; not to initiate or assist the prosecution of any claim for damages or cause of action which I or my heirs may have by reason of personal injury or death to participant or destruction to participant's property arising from the Balanced Fitness Programs.
8. CONTINUATION OF OBLIGATIONS
I agree, for myself and my heirs, that the above provisions, including ASSUMPTION AND AWARENESS OF RISK, RELEASE FROM LIABILITY, COVENANT NOT TO SUE, AND INDEMNITY AGREEMENT shall continue in full force and effect now and at all future times when participant is involved in any Balanced Fitness Program. In the event of any dispute or controversy arising with respect to this agreement, its interpretation, modification, application and/or extinction, said dispute or controversy will be resolved by binding mediation/arbitration.
The information based on the observation made during the exercise sessions of
Balanced Fitness Program will be treated as privileged and confidential; however, it may be used for a statistical or scientific purpose with your right to privacy retained.
10. DISCONTINUATION OF SERVICES
Coreen Wozniak’s Balanced Fitness LLC reserves the right to discontinue services to a client in the incidence of misconduct by a client or potential harm to a client.
10. PAYMENT FOR SERVICES
All payments for any Balanced Fitness Program must be paid in full, to Coreen Wozniak’s Balanced Fitness LLC no later than the first day of training.
You may refuse to participate or stop at any time during the exercise sessions. It is your decision. Please use common sense and consult your physician.