Exercise Consent Form

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This form can be downloaded in word format so you may make changes as needed. It’s important to understand that each state has different laws regarding consent forms. It’s up to you to find out what laws apply to you.

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Exercise Consent Form

I, the undersigned, hereby expressly and affirmatively state that I wish to participate in ______________________________. I realize that my participation in this activity involves risks of injury, including but not limited to (list) _____________________________________________ and even the possibility of death. I also recognize that there are many other risk of injury, including serious disabling injuries, which may arise due to my participation in this activity and that it is not possible to specifically list each and every individual injury risk. However, knowing the material risks and appreciating knowing and reasonably anticipating that other injuries and even death are a possibility, I hereby expressly assume all of the delineated risk of injury, all other possible risks of injury and even death which could occur by reason of my participation.

I have had an opportunity to ask questions. Any questions which I have asked have been answered to my complete satisfaction. I subjectively understand the risk of my participation I this activity, and knowing and appreciating these risks I voluntarily choose to participate, assuming all risk of injury or even death due to my participation.

_______________________________              ________________________________________

Witness                                                                         Participant

 

Date  _________________________

 

NOTE OF QUESTIONS AND ANSWERS

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

This is as stated, a true and accurate record of what was asked and answered.

­­­­­­­­­_______________________________

Participant

 

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