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

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

involved.

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

program.

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.

________________________________

Date:_______/_______/______

Signature

Print Name:________________________________

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