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Coach Joe’s Boxing & Fitness/The Double Jab® Personal Training Program
Informed Consent & Liability Release

General Statement of Program Objectives & Procedures:

I, the Client/Participant, understand that this physical fitness program may include exercises to build the cardiorespiratory system (heart and lungs), the musculoskeletal system (muscle endurance and strength, and flexibility), and to improve body composition (decrease of body fat in individuals desiring to lose fat, with an increase in weight of muscle and bone). Exercise may include aerobic activities (treadmill, walking, running, bicycle riding, rowing machine exercises, group aerobic activity, swimming, and other aerobic activities), callisthenic exercises, boxing, and weight lifting to improve muscular strength and endurance and flexibility exercises to improve joint range of motion.

Description of Potential Risks:

I understand that the reaction of the heart, lung, and blood vessel systems to exercise cannot always be predicted with accuracy. I understand there is a risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart attacks. Use of the weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures and precautions are not followed. I understand that Coach Joe’s Boxing & Fitness/The Double Jab® shall not be held liable for any damages arising from personal injuries sustained by the Client/Participant while and during the personal training program. Client/Participant using the exercising equipment during the personal training program does so at their own risk. Client/Participant assumes the full responsibility for any injuries or damages which may occur during the training.

Description of Potential Benefits:

I understand that a program of regular exercise for the heart, lungs, muscles, and joints, has many benefits associated with it. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement of physiological function, and decrease in heart disease.

Informed Consent & Liability Release:

I, (the undersigned), understand that by signing this Informed Consent & Liability Release, I am aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a program of strenuous physical activity including, but not limited to, boot-camp classes and other group or individual fitness activities, which may include the use of various pieces of fitness equipment offered by Coach Joe’s Boxing & Fitness/The Double Jab®. I am aware that participating in these types of activities, even when completed properly, can be dangerous. I agree to follow the verbal instructions issued by the exercise professional. I am aware that potential risks associated with these types of activities include, but are not limited to, death, serious neck and spinal injuries that may result in complete or partial paralysis or brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system, and serious injury or impairment to other aspects of my body, general health, and well-being.

Please initial the following:

(If the Client/Participant is a minor, the Parent/Guardian is required to initial, as well.)


I have read the foregoing information and understand it. Any questions which may have occurred to me have been answered to my satisfaction.


 Because of the dangers of participating, I recognize the importance of following the exercise professional’s instructions regarding proper techniques and training, as well as other organization rules. 


 I understand and warrant, release and agree that I am in good physical condition and it is my responsibility to consult a licensed physician and/or other medical professional before undertaking any type of exercise and/or fitness-training program or engaging in aerobic and/or other physical conditioning program. 


 I attest that I have no disability, impairment, or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition if I engage or participate. 


 I hereby consent to first aid, emergency medical care, and admission to an accredited hospital or an emergency center when necessary for executing such care and treatment of injuries that I may sustain while participating in a fitness-training program.


 I understand that I am responsible for obtaining my own medical insurance and will maintain thay insurance throughout my entire period of participation with Coach Joe’s Boxing & Fitness/The Double Jab®. I will assume any additional expenses incurred that go beyond my health coverage. 


I will notify Coach Joe’s Boxing & Fitness/The Double Jab® of any significant injury that requires medical attention (such as emergency care and/or hospitalization) and agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said fitness program now or as they may arise in the future.


 I hereby fully and forever release and discharge Coach Joe’s Boxing & Fitness/The Double Jab®, its assigns and agents from any and all claims, demands, damages, rights of action, present and future therein.

THIS INFORMED CONSENT & LIABILITY RELEASE (this “Agreement”) dated this day of November 18, 2024 in the State of New Hampshire BETWEEN:

(the “Client/Participant”)

OF THE FIRST PART

AND 

Joseph A. Pelletier IV
 (representative of Coach Joe’s Boxing & Fitness/The Double Jab®)

OF THE SECOND PART 

IN CONSIDERATION OF the convenants and agreements contained in this Agreement and other good and valuable consideration, the receipt of which is hereby acknowledged between the parties to this Agreement. This Agreement and its terms are contractual and not a mere recital.

First Client's Name

First Name*

Last Name*

Phone*
First Client's Age Acknowledgment*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Signature*
Second Client's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Client's Date of Birth*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Client's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
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.


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