Personal Training Program Registration Form and Waiver Please Print or TypeName: ________________________________________ Phone: ___________Mailing Address: _______________________________________________ _______________________________________________Email Address: __________________________Date of Birth: ___________________Age: ______________Gender: ______________Name of Emergency Contact: ________________________________________Phone Number of Emergency Contact: ________________________________Personal Training Program Policies:Each participant must sign a waiver and complete a health history questionnaire to
be kept on file and will be confidential between the personal trainer and the client.Participants must make appointments with at least _____ hours in advance or by
___________ (time) for _______________ (day of week) sessions.____________________ (Name of Trainer) must be notified _______ hours in
advance for cancellations; if notification is not at least _______hours in advance or
the session is missed the participant will be charged for the session.Participants ____ minutes late or more to a session will be charged for the session
and lose the training for the entire session. Clients are to meet the personal trainer at the agreed upon training venue at the
scheduled appointment time, unless an alternate meeting place as been agreed
upon between client and the personal trainer.For and in consideration of being allowed to receive personal fitness training from
_________________ (Name of Trainer) , and the mutual covenants contained in this
Agreement, and other good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged, the undersigned ___________________ (Name of
Participant) agrees to the above Personal Training Program Policies and does hereby
further agree to the following:1. It is hereby agreed that I, _____________________ (Name of Participant), do
fully comprehend and assume all risks involved in participating in this Personal Training
Program. I have been advised by ________________ (Name of Trainer) to consult my
physician prior to my participation in said Program to insure that I am physically able to
engage in strenuous physical activity.2.Being fully cognizant, and assuming all risks involved in the Personal Training
Program offered by ________________ (Name of Trainer) , I do hereby remise, release,
quitclaim, and forever discharge _________________ (Name of Trainer), his employees
or agents, administrators, successors and assigns, of and from any and all manner of
actions, suits, debts, accounts, damages, judgments, executions, claims, or demands
whatsoever in law or equity, or otherwise, against ___________________ (Name of
Trainer), his employees or agents, administrators, successors and assigns, which I, my
heirs, executors, or administrators hereafter can, shall or may have, for, upon or by
reason of any injury that I may sustain or incur while participating in the Personal Training
Program of ________________ (Name of Trainer), or while engaging in physical
conditioning exercises. 3.In consideration of being allowed to participate in said Personal Training Program,
I do hereby assume all risks of my involvement and do covenant and agree not to bring
legal action for damages should I sustain any injury, and do further release
_________________ (Name of Trainer) , his employees or agents, administrators,
successors and assigns from all acts of active or passive negligence on the part of
________________ (Name of Trainer) , his employees or agents, administrators,
successors and assigns. 4. I also agree to INDEMNIFY AND HOLD release _____________________ (Name
of Trainer), his employees or agents, administrators, successors and assigns harmless
from any and all claims, actions, suits, procedures, costs, expenses, damages, and
liabilities, including attorney’s fess brought as a result of my involvement in said Personal
Training Program and to reimburse them for any such expenses incurred.5.I do hereby certify and covenant that I am above the age of 18. Witness my signature this _________________ (date).
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(Printed Name of Participant)____________________________ (Signature of Participant)____________________________(Printed Name of Witness)____________________________(Signature of Witness)