Personal Training Fitness Assessment (Page 4 of 5) in pdf

18. Please list the habits that you would like to change____________________________________________________________________________

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19. On a scale of 1 – 10, (with 10 being very serious) how serious are you about achieving your goals?

20. Is there anything else your trainer should be aware of?_________________________________________________________________________

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RELEASE AND WAIVER OF LIABILITY

PARTICIPATION IN ANY ACTIVITY WITHIN THE RECREATION CENTER OR ANY OTHER RECREATION FACILITY

IS AT THE SOLE DISCRETION AND JUDGMENT OF THE MEMBER AND AT HIS OR HER OWN RISK.

I, the undersigned, assume full responsibility for death, injuries, catastrophic injuries or damages which may occur to me in, on, or

about the premises of the facility and do hereby fully and forever release and discharge THE UNIVERSITY OF MASSACHUSETTS, the

Board of Trustees, employees and representatives from any and all suits, claims, damages, costs and expenses of every kind in

conjunction with the use of the Campus Recreation facilities and thereof equipment associated.

I, the undersigned, acknowledge that the Personal Training Fitness Assessment hereunder includes participation in physical

activities, including but not limited to, various aerobic exercises, muscular endurance and or resistance training, flexibility and other

physical measurements. The member acknowledges these physical activities may be strenuous and may involve inherent risk of

physical injury. Member agrees to assume all risk and responsibility involved with participation in these physical activities.

I, the undersigned, certify that the information I have given on this form is complete and accurate.

Member’s Signature________________________________________ Date____________________________

Personal Training Fitness Assessment Page 4