First Name Last Name I agree to participate in a Gut Check Fitness Program. I recognize that exercise is not without varying degrees of risk to the muscoskeletal and/or cardiorespiratory systems. I hereby certify that I know of no medical problems (except those I have informed Gut Check Fitness of in the Client Information Sheet) that would increase my risk of illness and injury as a result of participation in a fitness program designed by Gut Check Fitness I understand and have been informed that there exists the possibility of adverse physical changes during the fitness program. I have been informed that these changes could include abnormal blood pressure, fainting, disorders of heart rhythm, stroke and very rare instances of heart attack or even death. I agree to waive, release, remise and discharge Gut Check Fitness & City of Encinitas and their agents, officers, principles and employees of any and all claims, demands, actions or damages of any kind resulting from participation in a Gut Check Fitness program. I further state that I understand and assume any and all risks associated with my participation in a Gut Check Fitness program. Your Initials
