Waiver Form - John Pilkington Personal Trainer printable pdf download

Disclaimer

I (name)_____________________________ understand that my participation in

exercise programmes, classes or events and any related activity conducted by John

Pilkington, Personal Trainer, is voluntary and at my own risk.

I am aware that exercise can be physically stressful and, in certain instances, can

even result in injury or cause death.

The levels of exercise that I will perform will be at my own pace, based upon my

cardio-respiratory (heart & lung) fitness, muscular strength and endurance.

I hereby state that I will inform the trainer of any symptoms (e.g. fatigue, shortness

of breath, chest discomfort, any pain/discomfort/concern for my safety/benefit) during

my participation in exercise. If I have high blood pressure, diabetes, a heart condition,

an existing injury, recent surgery or if I am taking any prescribed medications that

could affect my performance, I will inform the trainer prior to participating in any

exercise.

I understand that I will be given instructions on how to perform an exercise



and use equipment and I will ask the trainer any questions if I do not

understand.

I was offered the opportunity to be instructed on how to perform an exercise



and use equipment, however I declined because:

_____________________________________________________

_____________________________________________________(reason)

John Pilkington, Personal Trainer, will not be liable for any injuries or damage arising

out of participation or use of facilities to the undersigned. It is agreed that John

Pilkington, Personal Trainer, shall not be responsible or liable to the undersigned for

articles lost or stolen whilst making use of the facilities.

I acknowledge that I have read this document in its entirety and understand the

above. I have had the opportunity to ask questions and receive answers.

Client Signature:_______________________Date:____________________________

Print Name:___________________________

Trainer Signature:______________________Date:____________________________

Print Name:___________________________

Waiver Form - John Pilkington Personal Trainer