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I, the undersigned, do hereby voluntarily submit and hereby assume full responsibility for any or all damages, injuries, or loses that I may sustain or that may incur, if any, while attending or participating in any and all programs Longevity Personal Fitness may offer. I waive all claims against the owners, operators, and instructors of Longevity Personal Fitness, individually or otherwise, for any claims or injuries that I may sustain. I further understand that I am entering Longevity Personal Fitness’ programs at my own risk and that any medical treatment given to me will be the first aid treatment only. I declare that I do not have any limiting physical conditions, illnesses or disabilities which would prohibit participation in any programs offered by Longevity Personal Fitness. I understand that and agree to abide by the 24-hour cancellation policy which is stated as follows. All cancellations must be made 24 hours prior to set appointment time. If appointment is cancelled within 24 hours of appointment Longevity Personal Fitness has the right to charge the client in full of set appointment.

A physician’s examination should be obtained by all participants prior to involvement in the exercise program. If a participant does not obtain a physician’s permission the following statement must be signed:

I, the undersigned, have been informed of the need for a physician’s approval for participation in this program. I fully understand the strenuous nature of the program.

I accept complete responsibility for my health and well-being in the voluntary fitness program and related testing and understand that no responsibility is assumed by the leaders of the program or the sponsoring agency, Longevity Personal Fitness.

Your Signature

12 Holmes Street Millburn, NJ 07041



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