INFORMED CONSENT FORM

INFORMED CONSENT FORM

GET OUT OF PAIN PROGRAM

Name
Name
First
Last
GENERAL STATEMENT OF PROGRAM OBJECTIVES AND PROCEDURES:

I understand that this program includes moves to build the the musculoskeletal system for both muscular endurance, strength, and especially flexibility. Exercise may include some aerobic activity, functional muscle movement, corrective exercises to improve muscular imbalances, or weight lifting to improve muscular strength and endurance. There will be flexibility moves to improve joint range of motion and to increase suppleness in muscles that commonly pull on the joints causing pain.

DESCRIPTION OF POTENTIAL RISKS:

I understand that the reaction of the heart, lung, and blood vessel system to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart attacks. Use of the weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not followed. I understand that seller shall not be liable for any damages arising from personal injuries sustained by buyer while and during the GET OUT OF PAIN PROGRAM. Buyer using the exercising equipment during the GET OUT OF PAIN PROGRAM does so at his/her own risk. Buyer assumes full responsibility for any injuries or damages which may occur during the training.

I hereby fully and forever release and discharge seller, its assigns and agents from all claims, demands, damages, rights of action, present and future therein.

I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition if I engage or participate (other than those items fully discussed on health history form).

I state that I have had a recent physical checkup and have my personal physician’s permission to engage in aerobic and/or anaerobic conditioning.

DESCRIPTION OF POTENTIAL BENEFITS:

I understand that a program of regular movement for the muscles and joints has many benefits associated with it. These may include a decrease in pain in the joints such as back, neck, shoulder, knee, hip or other joint, improvement in flexibility, improvement in physiological function, and decrease in risk for heart disease.

I have read the foregoing information and understand it. Any questions which may have occurred to me have been answered to my satisfaction.