Waiver Form – TKFitness

This form is an important legal document. It explains the risks you are assuming by beginning an exercise program. It is critical that you read and understand it completely.

After you have done so, please sign and date at the bottom.

Waiver and Covenant not to Sue: I have volunteered to participate in a program of physical exercise under the direction of, Ted Kackley, which will include, but may not be limited to, weight and/or resistance training. In consideration of Ted Kackley’s agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless Ted Kackley and their respective agents, heirs, assigns, contractors from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with this or any exercise program including any injuries resulting therefrom. *

Please initial above.

Assumption of Risk: I recognize that exercise might be difficult and strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure, fainting, disorders in heartbeat, heart attack, and in rare instances, death. *

Please initial above.

I understand that as a result of my participation in an exercise program, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. *

Please initial above.

I recognize that an examination by a physician should be obtained by all participants prior to involvement in any exercise program. If I have chosen not to obtain a physician’s permission prior to beginning this exercise program with TKFitness, I hereby agree that I am doing so at my own risk. *

Please initial above.

In any event, I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. I acknowledge and agree that no warranties or representations have been made to me in regards to the results I will achieve from this program. I understand that results are individual and may vary. *

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Please sign name above.

Date of Signature (MM/DD/YY) *

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