Informed Consent And Liability Waiver Release For Participation In Exercise Program Form


Informed Consent and Liability Waiver Release for
Participation in Exercise Program
I agree and consent to the following:
I am voluntarily participating in the __________________________________
exercise/fitness program conducted by _______________________________
at the Hampton Community Center. I recognize that the program requires physical exertion that may
be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards
I understand that it is my responsibility to consult with a physician prior to and regarding my
participation in the above mentioned program. I represent and warrant that I have no medical condition
that would prevent my participation in the program.
I agree to assume full responsibility for any risks, injuries or damage know or unknown which I might
incur as a result of participating in the program. Such injuries may include, but are not limited to, heart
attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries
to knees, injuries to back, injuries to foot, or any other illness or soreness, including death.
I knowingly, voluntarily and expressly waive any claim I may have against the Town of Hampton or
_______________________ for injury or damages that I may sustain as a result of participating in the
I, my heirs or representatives forever release waive, discharge and covenant not to sue the Town of
Hampton or ___________________ for any injury or death caused by their negligence or other acts.
I have read the above waiver and release of liability and fully understand it contents. I voluntarily
agree to the terms and conditions stated above.
Print Name:________________________________


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