FACT Fitness
Advocare Nutrition Distributor

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FACT Fitness Coaching Program

Informed Consent for a Minor Client

We (parent and minor client) understand that this physical fitness program is individually tailored to meet the goals and objectives agreed upon by the personal coach, client, and parent. We understand, however, that the personal coach cannot guarantee that the client will accomplish the established goals. The program goals include (client, please initial all that apply):

___ Cardiovascular improvement?___ Increased strength?___ Decreased body fat?___ Other (list) ______Sport Performance Improvement

___ Improved muscular endurance ___ Improved flexibility?___ Weight loss  ___Improved Speed  ___Improved Agility  ___Improved Imbalances

We (parent and minor client) understand that the exercise program will involve participation in a number of types of fitness activities. These activities will vary depending upon the established objectives, but will probably include:?

aerobic activities including, but not limited to, the use of treadmills, stationary bicycles, step machines, rowing machines, and running track;

muscular endurance and strength building exercises including, but not limited to, the use of free weights, weight machines, calisthenics, and other exercise apparatus;

other activities selected by the personal coach and agreed upon by client and parent; and selected physical fitness and body composition tests.

Description of Potential Risks

The personal coach has explained that no exercise program is without inherent risks and that, regardless of the care taken by the personal coach, he (or she) cannot guarantee the personal safety of the client.

For example, when one induces cardiovascular stress through activity, injuries can range from minor injury (e.g., pulled muscles) to less frequent serious injury (e.g., heart attack, stroke, or other cardiovascular accidents) to the rare catastrophic incident (e.g., death, paralysis). Likewise, we know that engaging in muscular endurance, strength building, and other fitness activities sometimes results in minor injuries (e.g., bruises, musculo-skeletal strains and sprains), less frequently, more serious injuries (e.g., muscle tears, herniated disks, torn rotator cuffs), and rarely, catastrophic injury (e.g., death, paralysis).

We (parent and minor client) realize that when participating in any exercises or conditioning activity, there is always a possibility of minor injuries as well as a slight possibility of major injuries or catastrophic injury/death.

Description of Potential Benefits

We (parent and minor client) understand that a regular exercise program has been shown to have definite benefits to general health and well- being. We know that some of the physiological benefits of a regular exercise program can include loss of weight, reduction of body fat, improvement of blood lipids, lowering of blood pressure, improvement in cardiovascular function, reduction in risk of heart disease, improved strength and muscular endurance, improved posture, and improved flexibility. We further understand that regular exercise can have psychological benefits, often improving one’s outlook and feeling of well-being, as well as relieving tension and stress.

Client Responsibilities

We (parent and minor client) understand that it is the responsibility of the client to:

.    5)  fully disclose any health issues or medications that are relevant to participation in a strenuous exercise ?program;

.    6)  inform the coach if there are activities with which the client does not feel comfortable;

.    7)  cease exercise and report promptly any unusual feelings (e.g., chest discomfort, nausea, difficulty breathing, ?apparent injury) during the exercise program; and

.    8)  clear the client’s participation with a physician.


Client Acknowledgements

In agreeing to this exercise program, we (parent and minor client):

  • acknowledge that the client’s participation is completely voluntary.
  • understand the potential physical risks involved in the exercise program and believe that the potential ?benefits outweigh those risks.
  • give consent to certain physical touching that may be necessary to ensure proper technique and body ?alignment.
  • understand that the achievement of health or fitness goals cannot be guaranteed.
  • have had a voice in planning and approving the activities selected for the exercise program.
  • have been able to ask questions regarding any concerns and have had those questions answered to our ?satisfaction.
  • Acknowledge that the client is in good physical condition, has no impairment which might prevent ?participation in such activities, and have been advised to consult a physician prior to beginning this program.

have been advised to cease exercise immediately if the client experiences unusual discomfort and feels the ?need to stop. ?We (parent and minor client) have read and understand the above agreement. We have been made fully aware of and understand the potential risks involved in this physical fitness program. We hereby consent to those risks and assert that the client is freely and voluntarily participating in this program. Finally, we are freely signing this agreement. 


_________________________ __________ Signature of Client Date


_________________________ __________ Signature of Parent Date

_________________________ ___________ Signature of Coach Date

_________________________ ___________ Signature of Parent Date



Foundation Athletic Coaching Techniques