Waiver and Release Form

Please complete all sections accurately. All information is confidential.

If you prefer to fill out a hard copy, you can Download the PDF version here.

I understand there are inherent risks and hazards involved in participating in physical activity.
I attest that I am in sound physical condition.
I agree that in consideration of being permitted to use the fitness equipment:
(a) I release and hold harmless Karen Evans & Health Smart; including its principal, employees and agents from all liability arising out of personal injury, death or property loss which I may suffer arising out of or connected with my use of, participation and attendance of group, personal training sessions & or Health Coaching sessions.

(b) I do hereby waive as against Karen Evans & Health Smart: all claims or causes of action of any kind whatsoever in respect of personal injury, death or property loss which I may suffer arising out of or connected with my use of, participation and attendance of group, personal training sessions & or Health Coaching sessions.
This waiver and release is given notwithstanding that such personal injury, death or loss may have been caused solely or partly by the negligence of Karen Evans & Health Smart, its principal, employees and agents.

I have read, understood, and agree to the Waiver and Release terms above.

Client Name *

Client Email *

Signature Method: Draw signature Type your name

Client Signature (draw signature) *

Client Signature (type full name) *

Date *

Health Smart
Breakfast Point
NSW 2137

Karen Evans
Exercise Physiologist

Phone
0418 489 388

Email
info@health-smart.com.au

Contact Info