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General Statement of Program Objectives and Procedures: I understand that this physical fitness program may include exercises to build the cardio-respiratory system (heart and lungs), the musculoskeletal system (muscle, endurance, strength, and flexibility) and to improve body composition (decrease Body Fat in individuals needing to lose fat, with an increase in weight of muscle and bone). Exercises may include aerobic activities (treadmill, walking/running, bicycle riding, rowing machine exercise, swimming and other such activities). and weight lifting to improve muscular strength and endurance, and flexibility exercises to improve joint range of motion.

Description of Potential Risks: I understand that the reaction of the heart, lung, and blood vessel system to such exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occuring during or following exercise which may include abnormalities of blood pressure or heart rate, ineffective functioning of the heart, and in rare instances heart attacks. Use of the weight lifting equipment, and engaging in aerobic activity, can lead to musculoskeletal strains, pain, and injury if inadaquate warm-up, gradual progression, cool-down, and safety procedures are not followed.

Description of Potential Benefits: I understand that a program of regular exercise for the heart and lungs, muscles and joints, has many associated benefits. These may include a decrease in Body Fat, improvement in blood fats and blood pressure, improvement in psychological function, and a decrease in risk of heart disease.

I have read the forgoing information and answered the questions about my health. I understand that I am free to withdraw from this or any other physical fitness program without prejudice at any time I desire. I assume full responsibility for my participation in this physical fitness program and the consequences therof.

Date:

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