Client Release Form Name(Required) First Last Email(Required) 1) I wish to participate in the exercise and training program offered by Muscles in Motion, Inc. I understand there are inherent risks in participating in a program of strenuous exercise. Consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program within sixty (60) days of the date set forth below. No change has occurred in my physical condition since the date such approval was given which might affect my ability to participate in the fitness program. If a physician has not examined me, I agree to see a physician within sixty (60) days of the date set forth below to obtain his/her approval for my participation in a fitness program. I agree that Muscles in Motion, Inc shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge Muscles in Motion, Inc., its owners, employees, agents and/or assigns, from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only an injury caused by the gross negligence or intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators and assigns.(Required)I have read and understood this term. Please Initial:2) I certify that the answers to the questions outlined on the PAR-Q form completed during the Real Results Consultation are accurate. I acknowledge that medical clearance is required if I have answered “Yes” to any of the questions on the PAR-Q form. I understand and agree that it is my responsibility to inform my Personal Trainer of any conditions or changes in my health, now and on going, which might affect my ability to exercise safely and with minimal risk of injury.(Required)I have read and understood this term. Please Initial:3) I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Personal Trainer.(Required)I have read and understood this term. Please Initial:4) I understand the results of any fitness program cannot be guaranteed and my progress depends on my effort and cooperation in and outside of the sessions.(Required)I have read and understood this term. Please Initial:5) I understand that all Muscles in Motion, Inc. rates are based on 30 or 45 minute sessions and should I arrive late, there is no guarantee I will receive the full session with my trainer. In return, if my Personal Trainer is late for a session, I will still receive the full session time.(Required)I have read and understood this term. Please Initial:6) I understand that Muscles in Motion, Inc. bills all clients on a pre-pay basis. Once I have decided upon the type of training membership / package I will purchase, payment must be made before the sessions are scheduled or conducted. Credit cards, cash and checks made payable to Muscles in Motion, Inc. are all accepted.(Required)I have read and understood this term. Please Initial:7) I understand that Muscles in Motion, Inc. services are non-transferable and non-refundable. I also understand that all Muscles in Motion, Inc. sessions are pre-paid and must be redeemed within 6 months of purchase. All golf fitness packages expire within 10 weeks from start date.(Required)I have read and understood this term. Please Initial:8) I understand that Muscles in Motion, Inc. operates on a scheduled appointment basis for all services and thus, requires that I provide 24 hours notice when canceling an appointment. No charge will be levied should I cancel with MORE than 24 hours notice given; otherwise I understand that I will be charged for that session. I understand that Muscles in Motion, Inc. recommends that all cancelled sessions be rescheduled to ensure consistency and fitness progress.(Required)I have read and understood this term. Please Initial:9) I understand that during a training session, my trainer may have to use Touch Training to correct alignment and/or to focus my concentration on a particular muscle area to be targeted. If I feel uncomfortable or experience any type of discomfort with Touch Training, I will immediately request that my trainer discontinue using this technique.(Required)I have read and understood this term. Please Initial:10) I understand that the usage of any nutritional supplements is done under my own will and has not been prescribed by my Personal Trainer.(Required)I have read and understood this term. Please Initial:11) I understand that should my Personal Trainer become ill or is away on holidays, another trainer will be assigned to me so that my fitness progress does not suffer. I understand that all trainers at Muscles In Motion, Inc. are employees and I am not guaranteed to always work with the same trainer; though Muscles In Motion, Inc. will do our best to accommodate the clients’ preferences. I also understand that in the event that my Personal Trainer is no longer employed by Muscles in Motion, Inc., a suitable Personal Trainer will be re-assigned to oversee my program and workout sessions.(Required)I have read and understood this term. Please Initial:12) I understand that Muscles in Motion, Inc. may photograph some of their client events/sessions and I provide written approval for them to use these pictures for promotional purposes.(Required)I have read and understood this term. Please Initial:13) All children are strictly prohibited from the exercise floor unless working out with a personal trainer and a signed waiver is on file. Children under the age of 8 are required to be supervised.(Required)I have read and understood this term. Please Initial:I have read this Release and Terms of Agreement and I understand all of its terms. I sign it voluntarily and with full knowledge of its significance. Clients under the age of 18 must have a parent or guardian sign.(Required)Client Date(Required) MM slash DD slash YYYY Δ
