Informed Consent and Release of Liability for Participation
I hereby consent to voluntarily engage in a plan of Capoeira training activities that are recommended by my instructor to me for improvement of my general health and well being. The levels of exercise I perform will be based upon my cardiovascular and muscular fitness. I understand that I may be required to undergo a fitness assessment to evaluate my present level and/or obtain a physician consent to begin. I agree to participate in accordance with the Capoeira teacher's instruction.
If I am taking prescribed medications, I have already so informed my instructor and will inform said instructor of any changes my doctor or I make with regard to the use of prescription drugs.
I have been informed that during my participation in this program, I will voluntarily complete the physical activities unless symptoms such as fatigue, shortness of breath, chest discomfort, or similar occurrences appear. At any point, I understand that it is my complete right to decrease or stop exercise, and it is my obligation to inform my instructor of my symptoms.
I understand that during the performance of my program, physical touching and/or positioning of my body may be necessary to assess my muscular and bodily reactions to specific exercises, and to ensure that I am using proper technique and body alignment. I expressly consent to physical contact for these reasons.
I understand and have been informed that there exists the possibility of adverse changes and/or risk of bodily injury occurring during exercise including, but not limited to: abnormal blood pressure, fainting, dizziness, disorders of heart rhythm; in rare instances heart attack, stroke, paralysis, or death; and injuries to muscles, ligaments, tendons, and joints. I fully understand and accept the risks associated with exercise, and knowing these risks, it is my desire to participate as herein indicated and to assume full responsibility for my participation and actions.
I, for myself and on behalf of my spouse, heirs, assigns and personal representatives, hereby release, indemnify and hold harmless Soul Capoeira and their officers, agents and/or employees with respect to any and all injury, disability, death or loss or damage to person or property, whether due to or arising from the negligence or carelessness of the Releasees or otherwise, to the fullest extent permitted by law.
In accepting this Agreement, I acknowledge that I have read this entire Agreement, that I understand its terms, that I have had the time and opportunity to read and ask questions regarding the Agreement.