CONSENT FORM
I ________________________ have enrolled in a program of physical activity including, but not limited to,
bicycling and the use of various aerobic conditioning machinery offered by Lori Gregory
I am aware that participating in these types of activities, even when completed properly, can be dangerous.
I agree to follow the verbal instructions issued by Lori Gregory.
I am aware that potential risks associated with these types of activities include, but are not limited to, death,
serious neck and spinal injuries that may result in complete or partial paralysis or brain damage, serious injuries
to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, and
serious injury or impairment to other aspects of my body, general health and well being.
Because of dangers of participating, I recognize the importance of following the Personal Trainer's instructions
regarding proper techniques and training, as well as other organization rules.
I am in good health and have provided verification from a licenced physician that I am able to undertake a
generous fitness-training program. I have answered all questions on the PAR-Q form.
I hereby consent to first-aid, emergency medical care, and admission to an accredited hospital or an emergency
medical care center when necessary for executing such care and for treatment of injuries that I may sustain
while participating in a fitness-training program.
Date_____________________ Email___________________________________________________________
Signature_______________________________________________________ Phone #____________________