Informed Consent for participation in an Exercise Program for Apparently Healthy Adults
(Without Known or Suspected heart disease)

I hereby consent to voluntarily engage in an acceptable plan of exercises conditioning. I also give consent to be placed in program activities which are recommended to me for improvement of my general health and well-being. These may include dietary counseling, stress reduction, and health education activities. I will be given exact instructions regarding the amount and kind of exercise I should do. Professionally trained personnel 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. If I am taking prescribed medications, I have already so informed the program staff and further agree to inform them promptly of any changes which my doctor or I have made with regard to use of these.

I have been informed that during my participation in exercise, I will be asked to complete the physical activities unless symptoms such as fatigue, shortness of breath, chest discomfort or similar occurrences appear. At that point, I have been advised it is my complete right to decrease or stop exercise and that it is my obligation to inform the program personnel of my symptoms. I hereby state that I have been so advised and agree to inform that program personnel of my symptoms, should any develop.

It is my understanding and I have been so informed that there exists the remote possibility during exercise of adverse changes, including abnormal blood pressure, fainting, disorders of heart rhythm, and very rare instances of heart attack, stroke or even death, as well as other risks of injury or impairment, due to my participation in activity. Every effort, I have been told, will be made to minimize these occurrences by proper staff assessment of my condition before each exercise session, staff supervision during exercise and by my own careful control of exercise efforts. I underhand that there is a risk of injury, heart attack or even death as a result of my exercise, but knowing those risks, it is my desire to participate as herein indicated. I will not hold Lrfitnessinc. Or any of its officers or trainers accountable or liable should any of these aforementioned consequences or related injuries, illnesses, or negative effects result from participating in any part of any program I participate in.

I understand that this program may or may not benefit my physical fitness or general health. I recognize that involvement in the exercise sessions will allow me to learn proper ways to perform conditioning exercises and regulate my physical effort. These experiences should benefit me in 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 improve my exercise capacity after a period of 3-6 months.

I further understand that there are also other remote risks that may be associated with this program. Despite the fact that a complete accounting of all these remote risks is not entirely possible, I am satisfied with the review of theses risks which was provided to me and it is still my desire to participate.

I acknowledge that I have read this document in its entirety or that it has been read to me if I have been unable to read same.