Physical and Athletic Details

Non-Athletic Details

Your Health History

Fitness History

Diet & Miscellaneous Factors

RELEASE OF INFORMATION AGREEMENT

I, the signer of this document, in consideration of being coached in an endurance sport program by Healthy Results Personal Training, do hereby waive, release, and forever discharge Healthy Results Personal Training, and all employees and associates of Healthy Results Personal Training, including but not limited to Richard Pady, of all responsibility or liability from injuries or damage resulting from my participation in any activities or program. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of Healthy Results Personal Training. I understand and am aware that the program given to me from Healthy Results Personal Training, including the use of equipment, involves a risk of injury, and that I am voluntarily participating in the program and using my equipment with knowledge of the dangers involved. I here by agree to expressly assume and accept any and all risk of injury.

I do hereby further declare myself to be physically sound and suffering from no medical condition, impairment, disease, infirmity, or illness that would prevent my participation in any physical exercise program. Nor am I prevented, for any reason, from the use of exercise equipment or machinery except as may be noted hereinafter. I do hereby acknowledge that I have consulted with my physician regarding my intention to participate in a Healthy Results Personal Training program. The only restrictions I have respecting my ability to participate in this program are as follows: