I hereby stipulate and agree that Iam not at increased risk and do not need a medical evaluation: That I realize the risks of self testing, cardiovascular exercise, weight training and other forms of exercise as well as fitness and wellness testing and I am fully aware of the possibility of mechanical and/or other malfunctions of cardiovascular equipment, weight machines, and/or weight machines and apparatus, due to the negligence of FitTec or otherwise, as well as the possibility of injury to my person as a, result of the use of such cardiovascular equipment, weight machines, and/or weight machines and apparatus. I, therefore fully understand and I am mindful of the serious consequences which might result due to my involvement in cardiovascular exercise, weight lifting, body shaping, and/or therapeutic exercises (such as stretching) and procedures such as testing and evaluation with FitTec, and based
on that understanding, as set forth in this paragraph, I voluntarily assume any and all risk of loss, damage or injury of any kind what so ever from my use of any and all of the equipment, training, programming or evaluation, and facilities of FitTec, and further and with full knowledge of the consequences (i.e. that I am
waiving my right to sue) expressly waive any and all liability on the part of FitTec, as the operator of FitTec, and their respective trustees, beneficiaries, staff, and officers from my use of FitTec, its staff, an its equipment and facilities and any on line sources. I also release FitTec from liability for their negligence, defective equipment, injuries from dangerous conditions of property, etc. That I am forewarned that FitTec will not in any event provide medical and/or hospitalization insurance for my benefit, and in the event of an injury to my person occurring either as a result of my
being on any portion of the premises of FitTec. I will save harmless and keep indemnified FitTec and their respective trustees, beneficiaries, staff, and officers from and against any and all action claims, costs, expenses or demands, in respect of such injury or injuries, including death, howsoever caused, arising out of or in connection with my use of the FitTec facilities or my being on any portion of said premises and notwithstanding that the same may have been contributed to or occasioned by the negligence of FitTec,
and their respective staff, representatives, officers, directors, trustees and or beneficiaries. That I am hereby informed of my option to AGREE to a new release on each date that I make an appointment with FitTec or used said services or progams. However, I elect to forego that option and I therefore acknowledge and specifically intend that this release and waiver of rights shall be effective not only on the date hereof, but also on all occasions subsequent hereto when I shall use FitTec or AFTA prgrams. MAKING AN APPOINMENT OR FOLLOWING PROGRAMS (such as the I am Program) ARE AN AGREEMENT OF THIS WAIVER.
HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HEREBY AND
UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND DISCLAIMER IN FAVOR OF FITTEC AND ITS EMPLOYEES AND FOR WHOMEVER THEY ARE CONTRACTED WITH.
IF YOU ARE UNSURE OF YOUR MEDICAL STATE-PLEASE ANSWER THESE QUESTIONS. IF YOU ANSWER YES TO ANY OF THEM PLEASE ADDRESS THAT AT YOUR FIRST APPOINTMENT or use the PARQ,
Do you now, or have you had in the past any of the following:
1. History of heart problems, murmurs, palpitations, chest pain, or stroke?
2. Advice form a physician not to exercise?
3. High blood pressure?
4. Diabetes or thyroid condition?
5. High blood cholesterol (specify how much)?
6. History of heart problems in family (parents & siblings, list those with problems)?
7. Cigarette smoking habit (specify how much a day)?
8. History of breathing or lung problems (asthma)?
9. Muscle, joint (arthritis), sciatica, low back disorder, or any previous injury still affecting
10. Any chronic illness or condition?
11. Pregnancy (now or within the last 12 months)?
12. Obesity (over 20 % of ideal weight)?
13. Recent surgery (last 12 months)?
14. Difficulty with exercise?
15. Hernia, or any other condition that may be aggravated by lifting weight?
16. Dizziness or fainting spells?
17. Any physical limitation?
18. Do you take any medications that will affect you when exercising (if yes please
DISCLAIMER AND WAIVER