New class participant/Volunteer-Informed Consent Form

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(Please read in its entirety and sign below)

PARTICIPANTS:

I give my consent to Participate in the physical adaptive fitness evaluation program or group classes conducted by DPI Adaptive Fitness.

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, endurance, improved mobility, function, mood and decreased overall stress.

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

TESTING AND EVALUATION RESULTS

I understand that I may undergo initial testing to determine my current physical fitness status (1:1 assessment).

The testing may consist of completing a health inventory, taking a step test, Ski Erg or bicycle ergometer test for cardiovascular fitness, functional movement screens and being tested for muscular fitness and body composition.

I further understand that such screening is intended to provide (DPI) with essential information used in the development of individual or group adaptive fitness programs.

PHOTO RELEASE:

The use of Pictures may be implemented as baseline and ongoing measurements; I agree to release the use of pictures for educational & promotional purpose to (DPI). The testing will consist of completing this health inventory, taking a step test or bicycle ergometer test for cardiovascular fitness, functional movement screens and being tested for muscular fitness and body composition.
I further understand that such screening is intended to provide (DPI) with essential information used in the development of individual adaptive 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 or the services of my physician.

I will be provided a copy of all test results. I may share the results with whomever I please, including my personal physician.

WAIVER/RELEASE:

By signing this consent form I understand that I am personally responsible for my actions during my tenure at (DPI) whether in a group format or individual session and that I waive the responsibility of this group (DPI) if I should incur any injury as a result of my own negligence.

VOLUNTEERS ONLY:

I understand that as a volunteer I am allowed to observe only. I am not allowed to offer exercise guidance or be hands on with participants. As a volunteer I understand that I may inquire and ask questions about programming. My duties are to assist as instructed by trainers on staff at DPI.

Email *

Printed Full Name & Today's Date *

Electronic signature-Print full name to accept informed consent detailed above *

I am a *

Participant

Volunteer

Participants diagnosis (N/A if Volunteer) *

Please list any pertinent medical information our Adaptive Trainer team should be made aware of during your time with us in a group session *

Age & Date of Birth *

Address & phone number *

Emergency Contact Name & Relationship *

Emergency Contact Phone Number *

If participant under 18, Guardian full printed name

Electronic signature-Print full name to accept *

Submit

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