I, ________________________, certify and acknowledge:

That ________________________ Company name ________________________, an independent personal trainer, has advised me prior to my commencement of participation in cardiovascular and resistance training programs that such participation could result in physical injury.

That I, ________________________, freely and knowingly assume the risk in such programs, and I hereby waive any right, claim, or cause of action against ______________________________ Company name ________________________ and release him/her and/or his/her company from any liability for any injury, cost, damage expense or claim, which I or anyone on my behalf might incur as a direct or indirect result of my participation in this cardiovascular and resistance-training program.

That I, ________________________, have read this Liability Waiver form, understand and agree with each of the foregoing points, and have received a copy of this release form on this date.

Print Name: ________________________________________________

Signature: ________________________________________________

Date: ________________________________________________