Loading...

Informed Consent for Core for the Female Athlete class delivered online

Consent to partaking in an online exercise/rehabilitation class

I acknowledge and understand that the Athletic Therapist must be made fully aware of any current and existing medical conditions, which may be affected/exacerbated, by exercise. I also acknowledge that the therapist is not a physician and does not diagnose illness or disease or any other physical or mental disorder. I understand that it is my responsibility to keep the Athletic Therapist updated on my medical status and any changes that may occur. By signing below I declare that I have disclosed any pertinent medical information/conditions as mentioned above.

I hereby consent to partaking in an exercise class via online delivery. I understand that delivery of the class online is not exactly the same as delivery in person, but that Eryn Freeman will do her utmost due diligence to modify exercises as needed, provide exercise progression options, and present clear instructions via online. I recognize that all physical activity involves some degree of risk and that this risk is relative to my current level of health and fitness. Understanding that, I accept all risks of injury and illness, which may arise, as a result of my voluntary participation in this online fitness class. I will also not hold Eryn Freeman accountable for any accident that may occur during my involvement, including bodily harm or damage to self or others. I understand that I can stop participation in the class at any time, if it does not feel good, and will inform the Athletic Therapist of this.

I also understand that the class is delivered through a secure channel (Zoom), which is in line with PIPEDA. I also waive liability in the event of theft or compromise of information delivered through these electronic services. 

Dated: December 2, 2021

First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!