Boot camp informed consent for a minor Client

Program Objectives
We (parent/guardian and minor client) understand that the program is designed to help the client
reach his/her fitness goals and improve her/his health. We understand, however, that the coach can not
guarantee that the client will accomplish the goals that he/she establishes, though it is likely that she/he
will. We understand that because the program is in a camp format, the client will not receive as much
individual attention as a personal training format. The client's program goals are
!!"ardiovascular #mprovement !!#mproved $ndurance
!!#ncreased %trength !!#mproved &le'ibility
!!(ecreased )ody &at !!*verall Weight +oss
!!#ncreased ,uscle %i-e
!!*ther!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Description of the Exercise Program
We understand that the e'ercise program will involve participation in a number of types of
fitness activities. These activities will vary depending upon the clients established ob.ectives, but will
probably include
/. 0erobic activities including, but not limited to, .umping .acks, running, crawling, .umping rope,
kicking and punching1
2. ,uscular endurance and strength building e'ercises including, but not limited to, the use of free
weights, resistance tubes/bands, sticks, calisthenics, isometrics, and other training apparatus1
3. *ther activities selected by our coach1 and
4. selected physical fitness and body composition tests.
Description of Potential Risks
We understand that no e'ercise program is without inherent risks and that, regardless of the care
taken by our coach, we cannot guarantee the client's personal safety.
We understand that when one induces cardiovascular stress through activity, in.uries can range
from occasional minor in.ury (e.g., pulled muscles, muscle soreness) to infre5uent serious in.ury (e.g.,
heart attack, stroke, or other cardiovascular accidents) to the very rare catastrophic incident (e.g., death,
paralysis). +ikewise, we know that engaging in muscular endurance, strength building, and other
fitness activities occasionally results in minor in.uries (e.g., bruises, musculo6skeletal strains and
sprains), infre5uently, more serious in.uries (e.g., muscle tears, herniated disks, torn rotator cuffs), and
very rarely, catastrophic in.ury (e.g., death, paralyis).
We reali-e that when participating in any e'ercise or conditioning activity, there is always a
possibility that minor in.uries, ma.or in.uries, or catastrophic in.ury/death may occur.
Description of Potential Benefits
We understand that a regular e'ercise program has been shown to have definite benefits to
general health and well6being. We understand that some of the physiological benefits of a regular
e'ercise 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 fle'ibility. We further
understand that regular e'ercise can have psychological benefits, often improving one's outlook and
feeling of well6being, as well as relieving tension and stress.
Client Responsibilities
We understand that it is our responsibility to
/. &ully disclose any health issues (including diabetes, heart problems, sei-ures, and asthma) or
medications that are relevant to participation in a strenuous e'ercise program1
2. #nform the coach if there are activities with which we do not feel comfortable1
3. "ease e'ercise and report promptly any unusual feelings (e.g., chest discomfort, nausea,
difficulty breathing, apparent in.ury) during the e'ercise program1 and
4. "lear the client's participation with the client's physician.
Client Acknowledgments
#n agreeing to this e'ercise program, we, the parent/guardian and client
0cknowledge that our participation is completely voluntary.
7nderstand the potential physical risks involved in the e'ercise program and believe that the
potential benefits outweigh those risks.
8ive consent to certain physical touching that may be necessary to ensure proper techni5ue and
body alignment.
7nderstand that the achievement of health or fitness goals cannot be guaranteed.
9ave been able to ask 5uestions regarding any concerns we might have, and have had those
5uestions answered to our satisfaction.
9ave no impairment which might prevent the client's participation in such activities and have
been advised to consult a physician prior to beginning this program.
9ave been advised to cease e'ercise immediately if we e'perience unusual discomfort and feel
the need to stop.
We 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 are freely and voluntarily participating in this program. &inally, we are freely signing this
agreement.
!!!!!!!!!!!!!!!!!!!! !!!!!!!!! !!!!!!!!!!!!!!!!!!!! !!!!!!!!!
%ignature of "lient (ate %ignature of "oach (ate

%ignature of :arent/8uardian (ate %ignature of :arent/8uardian (ate