General Statement of Program Objectives and Procedures:
I understand that this physical fitness program includes exercises to build the cardio respiratory system
(heart & lungs), the musculoskeletal system (muscle endurance and strength, and flexibility), and to
improve body composition (decrease body fat in individuals needing to loose fat, with an increase in
weight of muscle and bone). Exercise may include aerobic activity, callisthenic exercises, and strength
training to improve muscular strength and endurance, and flexibility exercises to improve joint range of

Description of Potential Risks:
I understand that the reaction of the heart, lung, and blood vessel system to exercise cannot always be
predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or following
exercise which may include abnormalities of blood pressure or heart attacks. Use of equipment and
engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate
warm-up, gradual progression, and safety procedures are not followed.

I understand that The JK Movement shall not be liable for any damages arising from personal injuries
sustained by the participant while and during the training program. Participants using exercise equipment
during the training program does so at his/her own risk. Participants assume full responsibility for any
injuries or damages which may occur during the training. I hereby fully and forever release and discharge
The JK Movement, it’s assigns and agents from all claims, demands, damages, rights of action, present
and future therein. I understand and warrant, release and agree that the participant is in good physical
condition and that the participant has no disability, impairment or ailment preventing him/her from
engaging in active or passive exercises that will be detrimental to heart, safety, or comfort, or physical
condition if he/she engages or participates. I state that the participant has had a recent physical check-up
and the participant’s personal physician has given permission to engage in aerobic and/or anaerobic

Description of Potential Benefits:
I understand that a program of regular exercise for the heart, lungs, muscles and joints, has many
benefits associated with it. These may include a decrease in body fat, improvement in blood fats and
blood pressure, improvement in physiological function, and decrease in heart disease.
The participant and I have read the foregoing information and understand it. Any questions which may
have occurred to me or the participant have been answered to my satisfaction.
Participant's Name *
This will also act as a signature for acknowledging the above information
Date *
Parent/Guardian Name *
This will also act as a signature for acknowledging the above information
Date *
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