New class participant/Volunteer-Informed Consent Form (DPI & AFL Programming)

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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 sponsored by the Adaptive Fitness Legion

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 & ORIENTATION

I understand that I may undergo initial testing/orientation to the adaptive fitness gym in an attempt to determine my current adaptive physical fitness needs in a group format.

I understand that a full individual adaptive fitness assessment will be required for specific individualized programming and exercises that require individual attention and assistance.

Adaptive Fitness Assessments must be scheduled online

I further understand that such screening is intended to provide (DPI) with essential information used in the development of individual adaptive fitness programs and may also be helpful to educate our trainer team when you do participate in group class settings.

PHOTO RELEASE

The use of Pictures may be implemented as baseline and ongoing measurements; As promotional and as educational tools. I agree to release the use of pictures with my likeness for educational & promotional purpose to (DPI & AFL).

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 unless under the direct supervision of a certified and insured adaptive fitness trainer. 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 and to report to the Lead trainer/representative assigned.

Email *

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

Date *

YYYY

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 *

Is there any reason why you should not participate in an exercise program *

Have you had any recent hospitalizations or medical needs that we should be made aware of *

To the best of your knowledge are there medical restrictions limiting you from exercise activity *

Yes

Age *

Date of Birth
*

YYYY

Mailing Address *

Best Contact Number
*

Emergency Contact Name & Relationship *

Emergency Contact Phone Number *

How did you learn about AFL Programming? *

If participant under 18, Guardian full printed name

Participant: Electronic signature-Print full name to accept *

VOLUNTEERS ONLY:

Yes

Volunteer Electronic signature-Print full name to accept

Submit

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