WAIVER AND RELEASE OF LIABILITY

I, (print name)_____________________________, give my consent to participate in the fitness

program conducted by my personal trainer, Jayme Williams.

BENEFITS

Participation in a regular program of physical activity has been shown to produce positive

changes in a number of organ systems. These changes include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power and endurance.

RISKS

I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and

the cardiorespiratory system (dizziness, discomfort in breathing, heart attack). I hereby certify

that I know of no medical problem (except those noted on attached health questionnaire) that

would increase my risk of illness and injury as a result of participation in a regular exercise program.

EVALUATION

I understand that I will undergo initial testing to determine my current physical fitness status.

The testing will consist of completing the following health questionnaire and being tested for

muscular fitness and body composition.

I further understand that such screening is intended to provide my personal trainer, Jayme Williams, with essential information used in the development of individual fitness programs. I understand that my individual results will be made available only to me. I also understand that the testing is not intended to replace any other medical test of the services of my physician.

I will be provided a copy of all results of the evaluation upon my request. I may share the results with whomever I please, including my personal physician. By signing this consent form I understand that I am personally responsible for my actions during my tenure with Jayme Williams, and that I waive the responsibility Jayme Williams if I should incur any injury as a result of my negligence.

SERVICES

I have reviewed all the training packages available and I am signing up for the ______________ package. I agree to pay the amount of $__________ for # ______ weeks. I understand that a refund will not be issued if I choose not to participate in a scheduled session after my starting date. ¨ Please check if amount shown includes introductory session. Thank you.

NAME:__________________________________

SIGNATURE:_____________________________ DATE:______________

SIGNATURE OF PARENT:__________________

or GUARDIAN (for participants under the age of 18 years)