Note: If you would prefer to print and fill the form on paper, click below.
Have you been diagnosed with or exhibited symptoms of any of the following conditions?
Check the areas that have been injured both recently and in the past:
Because physical exercise can be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You agree that by participating in physical exercise, physical therapy or massage therapy activities, you do so entirely at your own risk. Additional recommendations for food supplements, or weight reduction products, are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and assume all risks of injury, illness, or death.
You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the trainer or therapist from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the trainer or therapist for personal injury or property damage.
If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from.
I retain Mobile Health & Fitness to render Personal Training, Physical Therapy, and/or Massage Therapy services.
I understand that I may cancel any appointment with my therapist by giving 24 hours’ notice. I also understand that if I fail to provide the aforementioned cancellation notice, as indicated, I will be charged for the full session fee.