Music for Health Exercise Clinics

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Liability Waiver/Informed Consent Form - please check all lines

Name:

I agree and consent to the following: *

I am voluntarily participating in the Music and Health Exercise Clinics conducted by the University of Toronto Music and Greater Toronto Area Dystonia Support/Dystonia Medical Research Foundation Canada

I recognize that this program involves physical exertion including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities and I am fully aware of the risks and hazards involved.

I hereby affirm that I am in good physical condition to participate in these activities and do not suffer from any know medical condition which could prevent my participation in this program.

I understand that it is my responsibility to consult with a physician prior to and regarding any concerns I may have about my participation in this 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 known or unknown which I might incur as a result of participating in the program.

I knowingly, voluntarily and expressly waive any claim I may have against the University of Toronto or Dystonia Support Group/Dystonia Research Foundation for injury or damages that I may sustain as a result of participating in the program.

I have read the above waiver and release of liability. I fully understand it contents, and I voluntarily agree to the terms and conditions stated above.

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