Personal Training Intake Form

Agreement and Release of Liability

In consideration of being allowed to participate in the activities and programs of Personalized Wellness Center and to use its facilities, equipment and machinery in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge its directors, officers, agents, employees, representatives and all others from any and all responsibilities or liability from injuries or damages resulting from my participation in any activites of my use of equipment or machinery in the above mentioned activities.  I also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for and injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting in their behalf or in any way arising out of or connected with my participation in any activities of exercise or the use of any equipment at Personalized Wellness Center

I fully understand that I may injure myself as a result of my participation and I release Personalized Wellness Center from any liability now or in the future, including but not limited to, heart attacks, muscle strains, muscle pulls or tears, shin splints, heat exhaustion, knee or foot injuries, back injuries and any other illness, soreness or injury caused, occurring during or after my participation at Personalized Wellness Center and I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved.  I understand this program does not provide any form of medical treatment, nor are its fitness professionals, licensed medical practitioners.  I hereby agree to expressly assume and accept any and all risks of injury or death.

I affirm by clicking submit, that I have read, understood, and agree to the above.