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Waiver/Liability Release and Assumption of Risk

To register to our gym please fill out the following medical form



SUNERGY FITNESS is an online personal training service provider. I, the undersigned, have requested SUNERGY FITNESS/Tia Kavulich (Personal Trainer) to conduct my Movement Assessments and Personal Fitness Training sessions through live meets or pre-written personalized workouts. I understand that the movement assessments allow my trainer to access my physical working capacity and appraise my fitness status. 


Participating in the activities and programs provided by the Personal Trainer, in addition to the payment of any fee or charge, I do hereby waive, release, and forever discharge the Personal Trainer and Sunergy Fitness from all responsibility or liability for injuries or damages resulting from my participation in any of the above-mentioned activities.  


I understand that stability, flexibility, strength, and aerobic exercise including using relevant equipment, are potentially hazardous activities. I also understand that exercise and fitness activities involve risk of injury and even death and that I am voluntarily participating in these activities and I hereby agree to expressly assume any and all risk. 


I am responsible for any and all equipment I will be using while under instruction of my trainer as well as the area that I will use this equipment. I am responsible for maintenance of all equipment used and accept any and all risks. 


I declare myself physically sound and have no conditions that prevent me from safely being involved in this exercise program. I declare that all of the answers on my Health Questionnaire are true and I understand that if anything changes in my health I must inform my trainer. 


I understand that if while performing these exercises or assessments I become dizzy, lightheaded, or have pain of any kind, I will cease activity and tell my trainer immediately. 


I acknowledge that I have either had a physical exam and have been given permission by my physician to participate, or that I have decided to participate in activity and equipment use without the approval of my physician and assume all responsibility for my participation and activities, and utilization of equipment in these activities. 


Thanks for submitting!

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