INFORMED CONSENT FOR FITNESS TESTING
FORM III
Name
(Please print)
The purpose of the fitness testing program is to evaluate cardirespiratory fitness, body
composition, flexibility, muscular strength and endurance. The cardiorespiratory fitness
test involves a submaximal test that may include a bench step test, a cycle ergometer
test or a one-mile walk for best time test. Body composition is analyzed by taking several
skinfold measurements to calculate percentage of body fat or by utilizing a hand held
bioelectric impedance analyzer. Flexibility is determined by a sit-and-reach test. Muscular
strength and upper-body endurance may be evaluated by the one-minute bent-knee situp test or the bench press test.
I understand that I am responsible for monitoring my own condition throughout the tests.
In the event unusual symptoms occur, I will cease my participation and inform the
instructor of my symptoms.
By signing this consent form, I confirm that I have read it in its entirety and that I
understand the description of the tests and their components. I also affirm that my
questions regarding the fitness testing program have been answered to my satisfaction.
In the event that a medical clearance form signed by my physician is required, I agree to
consult with my physician prior to participating in any fitness tests.
Additionally, I agree to assume the risk of such testing and further agree to hold harmless
the YMCA and its staff members for conducting such testing from any and all claims, suits,
losses or related causes of action for damages, including but not limited to, such claims
that may result from my injury or death, accidental or otherwise, during or arising in any
way from the testing program.
Date
(Signature of participant)
Date
(Person administering tests)
Phone | Address, City, NY Zip | BranchFamilyYMCA.org
INFORMED CONSENT FOR EXERCISE PARTICIPATION
FORM IV
I desire to engage voluntarily in the YMCA exercise program for the purpose of improving my
physical fitness. I understand that the activities are designed to gradually increase the workload on
the cardiorespiratory system and to thereby improve its function. The reaction of the
cardiorespiratory system to such activities can't be predicted with complete accuracy. There is a
risk of certain changes that might occur during or after the exercise. These changes might include
abnormalities of blood pressure or heart rate.
I understand that the purpose of the exercise programs is to develop and maintain
cardiorespiratory fitness, body composition, flexibility, muscular strength and endurance. A specific
exercise plan will be developed for me based on my needs, interests and doctor's
recommendations. All exercise programs include warm-up, exercise at target heart rate and cooldown. The programs might involve walking, jogging, swimming or cycling (outdoor and/or
stationary); participation in rhythmic aerobic exercises such as those performed in choreographed
fitness classes; calisthenics or strength training. All programs are designed to gradually increase
the workload on the body in order to improve overall fitness. The rate of progression is regulated
by the exercise target heart rate and perceived effort of exercise.
I understand that I am responsible for monitoring my own condition throughout the exercise
program and should unusual symptoms occur, I will cease my participation and inform the
instructor of the symptoms.
In signing this consent form, I confirm that I have read it in its entirety and that I understand the
nature of the exercise program. I also affirm that my questions regarding the exercise program
have been answered to my satisfaction.
In the event that a medical clearance form is required prior to my participation in the exercise
program, I agree to consult with my physician and obtain clearance from him/her before beginning
an exercise program.
I agree to assume the risk of such exercise and further agree to hold harmless the YMCA and its
staff members conducting the exercise program from any and all claims, suits, losses or related
causes of action for damages, including but not limited to, such claims that may result from my
injury or death, accidental or otherwise, during or arising in any way from the exercise program.
Date
(Signature of Participant)
Name
Address
Date of Birth
Telephone
Name of personal physician
Physician's phone
Limitations and Medications
Phone | Address, City, NY Zip | BranchFamilyYMCA.org