Victoria Wellness Professionals

I, ________________________, give my consent to participate in the physical fitness evaluation program conducted by Victoria Wellness Professionals.

Benefits

Participation in a regular program of physical activity has shown to produce positive changes in a number of organ systems. These changes include increased work capacity, improved cardiovascular efficiency and increased muscular strength, flexibility, power and endurance.

Risks

I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack). I hereby certify that I know of no medical problem (except those noted below) that would increase my risk of illness and injury because of participation in a regular exercise program.

Testing And Evaluation Results

I understand that I will undergo initial testing to determine my current physical fitness status. The testing will consist of completing a health inventory, treadmill testing for gait analysis, body composition testing, blood pressure and resting heart rate, and performance of various exercises involved in the integrated fitness profile.

I further understand that such screening is intended to provide Victoria Wellness Professionals with essential information used in the development of individual fitness programs. I understand that my individual results will be made available only to me. I also understand that the testing is not intended to replace any other medical test or the services of my physician. By signing this consent form, I understand that I am personally responsible for my actions during my tenure at Victoria Wellness Professionals and that I waive the responsibility of this center if I should incur any injury because of my negligence.

Signed: ______________________ Date: _____________________

Witness: ______________________ Date: _____________________