Consent & Waiver

Purpose and Explanation of the Class

The Employee Wellness Program (EWP) offers both open exercise sessions and yoga classes. The open exercise sessions allows you to exercise on your own under the guidance and supervision of the EWP staff or you may choose to participate in one of our staff-led programs. A variety of exercises are available including strength training, aerobic conditioning, and flexibility. The selection of exercises and the intensity of the exercises must be appropriate based on your health history and current level of fitness. EWP sessions are staffed by trained personnel and students with education in Kinesiology. 

 

Attendant Risk and Discomforts

There are inherent risks associated with all forms of physical activity including strength training, aerobic conditioning and flexibility. Strength training may result in acute muscle and/or joint pain, pulled muscles, brief changes in blood pressure, light headedness, dizziness, delayed onset muscle soreness (DOMS), more chronic conditions such as tendonitis, and other discomforts. Strength training should be modified or postponed if joint injury is present or if pain or symptoms persist. Aerobic conditioning may result in fast or slow irregular heart rhythm, abnormal blood pressure changes, light headedness, dizziness, fainting, chest pain, and other discomforts. Any type of physical activity may in rare instances lead to heart attack, stroke or death, but this is unusual, especially in participants free of known coronary heart disease (CHD), free of any signs or symptoms of CHD, and with few major risk factors of CHD. All EWP staff are trained in basic cardiac life support (CPR) and are trained to watch for any signs or symptoms associated with a poor exercise response.

 

Responsibilities of the Participant

To promote the safety and benefit of your participation in the open exercise or yoga sessions at the EWP, it is important that you fully disclose your personal health history, any medications you are taking, and any symptoms you may be experiencing during exercise. Such symptoms would include joint pain, irregular heart rhythm, tightness or pressure in your chest, unusual shortness of breath, light headedness, dizziness and the like. It is also important that you adhere to the recommendations of the EWP staff especially with regard to the choice and intensity of exercises you perform. You should not exceed the recommended exercise intensity (as measured by weight lifted or exercise heart rate) and you should not exercise when you are injured, sick or not otherwise feeling well.

 

Benefits to be Expected

It is expected that you will see benefits as a result of regular and consistent participation in the open exercise or yoga sessions. Strength training typically results in numerous physical benefits (including improved muscle strength, increased muscle mass and increased bone density) and possibly in an improvement in physical tasks associated with work, recreation and every day life. Aerobic conditioning typically results in health benefits (including improved body composition, reduced blood pressure and reduced risk of CHD) and possibly in changes associated with improved exercise performance (including increased aerobic capacity, improved heart and lung function and improved circulation).

 

Inquiries

An important part of the informed consent process is providing you the opportunity to inquire about any aspect of the EWP open exercise sessions or yoga. If you have any questions or concerns about the class, please feel free to ask any member of the EWP staff.

 

Use of Medical Records and Information

Any information gathered in conjunction with the class (such as health history information, signs or symptoms of disease, risk of disease, exercise risk, blood pressure, body composition, aerobic fitness, instances of joint pain, chest pain, light headedness or dizziness, etc.) will be kept confidential to the extent provided by law. No identifiable information will be released or revealed to any other party without your written consent. You may be asked, however, to allow certain information (from which your identity is removed) to be used for research or educational purposes.

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

I acknowledge that using gym facilities, equipment, and participating in physical exercise involves inherent risks, including but not limited to physical injury, strain, discomfort, and the possibility of serious injury or death. I assume all risks and responsibility for any injuries or other medical incidents.

If I am accidentally injured during the open exercise or yoga session, the EWP staff will offer immediate first aid (if needed) but will be unable to provide treatment. If injured, I will be responsible to seek treatment with my own physician or primary care provider.

I hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in physical activity. I acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in.

I acknowledge that I have read this form in its entirety or it has been read to me, and I understand my responsibility in the open exercise and yoga sessions in which I will be engaged. I accept the risks, rules, and regulations set forth. Knowing these, and having had an opportunity to ask questions which have been answered to my satisfaction, I consent to participate in the open exercise sessions.

After having read this consent & waiver and knowing these facts, and in consideration of acceptance of my participation and the Employee Wellness Program furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE the Employee Wellness Program, its officers, agents, employees, organizers, representatives, and successors from any responsibility, liabilities, demands, or claims of any kind arising out of my participation in the Employee Wellness Program sessions, assessments and/or events.

On the next page, you will see a summary of your responses so that you can save a copy for your records.