1. PURPOSE AND EXPLANATION OF PROCEDURE
I hereby consent to voluntarily engage in an acceptable plan of personal fitness training. I also give consent to be placed in personal fitness training program activities which are recommended to me for improvement of dietary counseling, stress management, and health/fitness education activities. The levels of exercise I perform will be based upon my cardiorespiratory (heart and lungs) and muscular fitness. I understand that I may be required to undergo a graded exercise test prior to the start of my fitness training program in order to evaluate and assess my present level of fitness.
I will be given exact personal instructions regarding the amount and kind of exercise I should do. A professionally trained personal fitness trainer will provide leadership to direct my activities, monitor my performance, and otherwise evaluate my effort. Depending upon my health status, I may or may not be required to have my blood pressure and heart rate evaluated during these sessions to regulate my exercise within desired limits. I understand that I am expected to attend every session and to follow staff instructions with regard to exercise, stress management, and other health and fitness regarded programs. If I am taking prescribed medications, I have already so informed the program staff and further agree to so inform them promptly of any changes which my doctor or I have made with regard to use of these. I will be given the opportunity for periodic assessment and evaluation at regular intervals after the start of the program.
I have been informed that during my participation in the above described personal fitness training program, I will be asked to complete the physical activities unless symptoms such as fatigue, shortness of breath, chest discomfort or similar occurrences appear. At this point, I have been advised that it is my complete right to decrease or stop exercise and that it is my obligation to inform the personal fitness training program personnel of my symptoms, should any develop.
I understand that during the performance of exercise, a fitness trainer will periodically monitor my performance and, perhaps measuring my pulse, blood pressure, or assess my feelings of effort for the purposes of monitoring my progress. I also understand that the fitness trainer may reduce or stop my exercise program when any of these findings so indicate that this should be done for my safety and benefit.
I also understand that during the performance of my fitness training program physical touching and positioning of my body may be necessary to assess my muscular and bodily reactions to specific exercises, as well as to ensure that I am using proper technique and body alignment. I expressly consent to the physical contact for the stated reasons above.
2. RISKS
It is my understanding and I have been informed that there exists the remote possibility during exercise of adverse changes including, but not limited to, abnormal blood pressure, fainting, dizziness, disorders of heart rhythm, and in very rare instances heart attack, stroke, or even death. I further understand and I have been informed that there exists the risk of bodily injury including, but not limited to, injuries to the muscles, ligaments, tendons, and joints of the body. Every effort, I have been told, will be made to minimize these occurrences by proper staff assessments of my condition before each personal fitness training session, staff supervision during exercise and by my own careful control of exercise efforts. I fully understand the risks associated with exercise, including the risk of bodily injury, heart attack, stroke or even death, but knowing these risks, it is my desire to participate as herein indicated.
3. BENEFITS TO BE EXPECTED AND ALTERNATIVES AVAILABLE TO EXERCISE
I understand that this program may or may not benefit my physical fitness or general health. I recognize that involvement in the personal fitness training sessions will allow me to learn proper ways to perform conditioning exercises, use fitness equipment and regulate physical effort. These experiences should benefit me by indicating how my physical limitations may affect my ability to perform various physical activities. I further understand that if I closely follow the program instructions, that I will likely improve my exercise capacity and fitness level after a period of 3-6 months.
4. CONFIDENTIALITY AND USE OF INFORMATION
I have been informed that the information which is obtained in this personal fitness training program will be treated as privileged and confidential and will consequently not be released or revealed to any person, to the use of any information which is not personally identifiable with me for research and statistical purposes so long as same does not identify my person or provide facts which could lead to my identification. Any other information obtained, however, will be used only by the program staff to evaluate my exercise status or needs.
5. PAYMENT
I will provide a credit or debit card number for Fit 4 Life Cle to keep on file in our secure system. All Fit 4 Life Cle training memberships are billed monthly on a predetermined date. You are allowed to pay in full if needed. If you wish to pay in cash or by check you will be required to submit your payment 10 days before your billing date or we will charge the card on file. Fit 4 Life Cle accepts visa, discover, and MasterCard and assures you that your information is kept safe.
Your membership program must be used within the month. You are not allowed to carry over sessions from month to month. If you do not use sessions they are lost, however, you are allowed to make up missed sessions within the month by coming to different times or extra days. If you have to travel for a long period of time or become ill please let us know before your billing date and your account will be suspended for up to three months. Any extenuating circumstances should be brought to the attention of the Director of Fitness for review. Fit 4 Life Cle will handle these on a case by case basis.
6. PACKAGE CANCELLATION
Cancelations requests can be made at any time within the terms of the contract. A cancellation requested at least 5 business days before your next billing date should result in no further recurring billing. If less than 5 business days, you may be billed one more time. If you are still within the initial term of your contract, your cancellation will be effective when your term is over.
If you do decide to cancel your membership, you can still use the club for the additional time covered by the pre-paid last month’s dues we collected at enrollment. Your last month prepaid dues will be applied to the month AFTER the month paid by your final recurring billing, and your membership will expire at the end of that prepaid last month.
7. REFUNDS
In the event that a medical problem or prolonged circumstances prevents completion of the contracted term the Client may take an extended period of time to complete terms or ask for a refund. Length of extension or amount to be refunded will be determined upon presentation of medical documentation at the discression of Fit 4 Life Cle.
8. INQUIRIES AND FREEDOM OF CONSENT
I have been given an opportunity to ask questions as to the procedures.
I have read this Informed Consent form, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily, without inducement.