Health Waiver

To register to our programs please fill out the following medical form

First Name

Last Name

Email Address

Do you have a doctor’s permit to participate in physical activities?

Yes

I, the undersigned, have voluntarily enrolled in an exercise class offered by Ruth Elise Foss. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, stretching and other various fitness activities. I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health and to the awareness, care, and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in the exercise program brings with it my assumption of those risk or results stemming from this choice. I, the undersigned, being aware of my own health and physical condition am voluntarily participating in this program program and understand that I may discontinue participation at any time. I understand that any exercise program has an associated risk of minor injury to major injury to sudden death. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I assume the responsibility for discontinuing any exercise that causes pain and will consult the doctor regarding any discomfort. Having such knowledge, I hereby release Ruth Elise Foss, her representatives, agents, employees, and successors from any and all claims, demands, injuries, damages, actions, or causes of actions which arise as a result of my participation in her exercise classes. I declare that I have read, understood and agree to the contents of this informed consent.

I declare that the info I’ve provided is accurate & complete

Initials

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Health Waiver