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Waiver &Release

Because physical exercise can be strenuous and subject to risk of serious injury, we urge all individuals to obtain a

physical examination from a doctor before using any exercise equipment or participating in any exercise activity.

I certify that I am cognizant of all of the inherent dangers of participating in physical exercise or training activities

and am electing to participate entirely at my own risk. Any recommendation for changes in diet including the use

of food supplements, weight reduction and/or body building enhancement products are entirely my responsibility

and I understand I should consult a physician prior to undergoing any dietary or food supplement changes. I agree

that I am voluntarily participating in these activities and use of these facilities and premises and personally assume

all risks of injury, illness, or death. Neither the trainers, owners, instructors, nor The Well Built Woman, LLC dba

Well Build Coaching are responsible for any personal injury or loss of personal property.

I acknowledge that I have carefully read this “waiver and release” and fully understand that it is a release of

liability. I am expressly agreeing to release and discharge the trainers, owners, instructors, and The Well Built

Woman, LLC dba Well Build Coaching from any and all claims or causes of action and agree to voluntarily

give up or waive any right that I may otherwise have to bring a legal action against the trainers, owners,

instructors, nor The Well Built Woman, LLC dba Well Build Coaching for personal injury or property damage.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence.

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.

By signing this release, I acknowledge that I understand its content and that this release cannot be modified

orally.

Has your doctor ever said you have a heart condition OR high blood pressure?
Do you experience pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? (Please answer NO if your dizziness was due to overbreathing including during vigorous exercise.)
Have you ever been diagnosed with a chronic medical condition (other than heart disease or high blood pressure)?
Are you currently taking any prescribed medications for a chronic medical condition?
Do you currently have (or have had in the past 12 months) a bone, joint, or soft tissue (muscle, ligament, tendon) condition, injury, or problem?

Thanks for submitting!

Nutrition Coaching & 

Personal Training