I hereby consent to engage in an acceptable plan of exercise. I also give consent to follow a structured program that is recommended to me for improvement of my general health and well-being. This plan may include exercises, dietary counseling, stress reduction, and health education activities. I will be given exact instructions on the amount and kind of exercise I should do. I understand that I am to follow instructions given to me in regards to nutrition, exercise, and stress management. If I am taking prescribed medicine I have already indicated that on the preparticipation form and agree to notify my trainer if my medications change. I understand that if any symptoms occur while exercising, such as fatigue, shortness of breath, lightheadedness, dizziness, or chest discomfort, I should decrease or stop exercising immediately. I hereby state that I will inform my trainer should these, or other, symptoms occur. I understand that should any injuries occur while I am exercising I should contact medical personnel. I agree that my trainer is not liable for any injuries that occur while following the structured training program. I understand the risks of exercise which may in some rare cases include abnormal blood pressure, fainting, disorders of heart rhythm, and very rare instances of heart attack or even death. I will minimize these risks by monitoring myself and controlling my exercise efforts. I understand that there is risk of injury, heart attack, or even death as a result of my exercise, but knowing those risks, I desire to participate as indicated herein. I have been informed that all information obtained in this training program will be kept confidential, and will not be released or revealed unless I give my written consent to release information. I understand that the information requested is for my trainer’s use to prescribe an exercise program that will benefit me. I further understand that there are also other remote risks that may be associated with this program. Despite the fact that a complete accounting of these remote risks has not been provided to me, I still desire to participate. I accept responsibility from the payment of the services provided to me. I understand that payment is made in full at the start of the program and there are absolutely no refunds under any circumstances. I acknowledge that I have read this document in its entirety or that it has been read to me if I am unable to read. I consent to the execution of all services and procedures as explained herein by all program personnel.