New class participant-Informed Consent
I, (print name) _______________________________________ , give my consent to participate in the physical adaptive fitness evaluation program or classes conducted by DPI Adaptive Fitness.
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.
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 will undergo initial testing to determine my current physical fitness status (1:1 assessment). The use of Pictures may be implemented as baseline and ongoing measurements; I agree to release the use of pictures for educational 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.
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.
Participants Printed Full Name & Date
Participants Age & Date of Birth
Participants Address & phone number
Emergency Contact Name & Relationship
Emergency Contact Phone Number
If participant under 18, Guardian full printed name
Participant Electronic signature-Print full name to accept
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service