Personal Training Informed Consent, Waiver and Release

I do hereby consent to participate in a personal training program that may include weight

training and/or cardiovascular exercise. Because physical exercise can be strenuous and

subject to risk of serious injury (including but not limited to musculoskeletal injury, spinal injuries,

abnormal blood pressure responses, and rare instances heart attack or death), it is urged that I

obtain a physical examination from a doctor before using any exercise equipment or

participating in any exercise activity. I agree that by participating in physical exercise or training

activities, I do so entirely at my own risk.

Any recommendation for changes in diet including the use of food supplements, weight

reduction and/or body building enhancement products are my responsibility and I agree that I

have been informed to consult a physician prior to undergoing any dietary or food supplement

changes. I agree that I am voluntarily participating in these activities and assume all risks of

injury, illness, or death.

This waiver and release of liability includes, without limitation, all injuries which may occur as a

result of:

a) my participation in any activity, class, program, personal training, supervision, or instruction,

b) instruction, training, supervision, or dietary recommendations made by Ashley Lashaway and Mama Said Move

c) the use of the facilities, equipment, or premises at West Pelvic Wellness.

I expressly release and discharge Ashley Lashaway, Mama Said Move, and West Pelvic Wellness,

including its owners, employees, and agents from any and all claims or causes of action, and I voluntarily

give up or waive any right that I may otherwise have to bring a legal action for personal injury or property damage.

If any portion of this release from liability is deemed invalid by a court of competent jurisdiction,

the remainder shall remain in full force and effect. By signing this release, I acknowledge that I

understand its content and that this release cannot be modified orally.

Client: _______________________________________

Printed Name: _________________________________

Date: _________________________________________