Consent Form

Informed Consent/Release of Liability Form
Lenexa Strength & Fitness

I (print name)_____________________________, give my consent to participate in the physical fitness evaluation and program conducted by Lenexa Strength & 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 and endurance.

Risks:  I recognize that exercise can be strenuous & carries some risk to the musculoskeletal system (sprains, strains) and the cardio-respiratory system (dizziness, discomfort in breathing, heart attack).  I know that I should not undertake such activity unless I am medically able.  I also know that the ultimate responsibility for my safety rests with me.  I assume these risks fully.  Any health concerns noted on my Health History Questionnaire have been addressed with my physician, and any specific guidelines or limitations addressed by my physician have been documented in writing and attached to this form.  I hereby certify that I know of no other medical problems that would prevent me from safely participating in a regular exercise program.  In consideration of being allowed to use the equipment and services of Lenexa Strength & Fitness, I hereby for myself, heirs, executors, administrators and all others who might claim in my behalf, release the owners of Lenexa Strength & Fitness from any and all liability arising from my use of the fitness facility and personal training services.

Testing and Evaluation Results:  I understand that I may undergo periodic testing to determine my current physical fitness status.  In addition to completing the Health History Questionnaire, the evaluation/testing may consist of a cardiovascular and/or muscular fitness test, and body composition/measurement assessments.

I further understand that such a screening is intended to provide Lenexa Strength & Fitness with essential information used in the development of individual 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 may obtain a copy of all test results and I may share these 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 Lenexa Strength & Fitness, and that I waive the responsibility of this center if I should incur any injury as a result of my negligence.

Signed:___________________________________________  Date:_________________

Witness: __________________________________________  Date:_________________