If you answered no to all of the questions above, you are cleared for physical activity. By entering your name below, you are agreeing that all of the questions above have been answered truthfully and agree to the following participant declaration: *

I, the undersigned, have read, understood to my full satisfaction and completed the questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. It is my responsibility to advise my trainer if anything changes that would alter one or more of the answers given above. I also acknowledge that Mountain Wellness Studio may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with the applicable law. If you answered yes to one or more of the questions, I will send you more detailed questions in Part 2 of the questionnaire.

Informed Consent:

I understand that participation in the Strength2Move class involves physical exertion and may carry some risk of injury. I have been informed of the nature of the activities involved and I understand that it is my responsibility to communicate any physical limitations or concerns to the instructor prior to the class.

Health Status:

I affirm that I am in good physical condition and do not suffer from any medical conditions that would prevent me from participating in physical exercise. If I have any concerns about my health or physical condition, I have consulted with a medical professional prior to participating in this class.

Assumption of Risk:

I understand that there are inherent risks associated with physical activity and I voluntarily assume full responsibility for any and all risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the Strength and Mobility class.

Release of Liability:

I hereby release, waive, discharge, and covenant not to sue the instructor, the facility, or any staff involved with the Strength and Mobility class from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in the class or as a result of participation in a class.

Photography and Video Release:

I understand that photographs and videos may be taken during the class for promotional purposes. I hereby give consent for my image or likeness to be used in promotional materials without compensation.

Agreement:

I have read and fully understand the terms of this consent form. By digitally signing below, I acknowledge that I am voluntarily participating in the Strength and Mobility class and agree to abide by all rules, instructions, and limitations provided herein.