"Where Champions Train"
1000 South State Street
Clarks Summit, PA 18411
Brown's Gym trainers will make various efforts to minimise any potential risks. However, you must be aware that exercise has some potential side effects and risks. It is possible throughout the exercise assessment, training sessions or your program that you may experience abnormal blood pressure, irregular heart rhythm, dehydration, fainting and/or dizziness. It is also possible that you might seriously injure yourself from the use of exercise equipment, failure of exercise equipment, tripping or falling, or other hazards associated with equipment, moving around while exercising, and your surroundings. In very rare circumstances, it is possible that exercise can cause heart attack, stroke or death. It is extremely important that any physical or other symptoms that you experience whilst participating in the program are explained to staff, even if you feel that they might not be important. It is also important that you tell your trainer any information you possess about your health status, or changes to your health during the course of your program, especially those that relate to heart problems including shortness of breath, Informed Consent and Release of Information for Participation in Exercise pain, pressure, tightness or heaviness in the chest, neck, back, jaw, calf area and/or arms. By telling your trainer this information you are minimising your risk or injury, complications and death. It is expected that you will tell your trainer all medications you use, begin to use or cease using (including non-prescription) prior to participation in your initial or regular training sessions. It is also expected that any short term changes to your usual medication regime are reported to your trainer (e.g. forgetting to take your medication one morning).
I understand all of the information and instructions outlined in this informed consent, have had time to discuss any concerns with a health professional, and considering this, agree to participate in a Brown's Gym program at my own risk.
I also agree to release and indemnify Brown's Gym from or against any actions or claims arising from any injury, loss, damage or death caused to me. I also give permission for Brown's Gym to use my image / name in the of the above promotional outlets listed.
I hereby consent to voluntarily engage in the exercise program considering the above information.
I understand what is expected of me and the risks and procedures associated with this program. After fully reading this document I voluntarily consent to participate in the exercise program.
Confidentiality and Non-Disclosure. Client acknowledges and agrees that the information provided by Trainer iscustomized for Client, is proprietary to Trainer and is therefore confidential. The information will be used solely andexclusively by Client. Client agrees not to disclose the information to any third party (other than Client’s treating physician).Client agrees not to disclose the information on forum journals, web blogs, personal websites, commercial websites, literarypublications or otherwise. Client acknowledges and agrees that this duty of confidentiality and non-disclosure will continuedespite the completion, cancellation or termination of the Services under this Agreement. Client agrees to return all copies ofthe information and to take all reasonable measures to prevent the unauthorized disclosure of the information and to preventunauthorized person or entities from having access to the information.
Upon a breach of this duty of confidentiality and non-disclosure by Client, Trainer has the right to: i) immediately terminate this Agreement, without; ii) obtain an injunction restraining Client for any further dissemination of the information; and iii) to pursue all other remedies allowed by law or in equity. Client agrees to indemnify and hold Trainer harmless for all losses, claims, damages or attorney fees arising from Client’s breach of these confidentiality and non-disclosure provisions