WellSpan Results Fitness Application

Please note: If you are under the age of 18, you will need to complete our paper application with a signature of a parent or guardian.

Agreement and release of liability for WellSpan Results Therapy & Fitness

The undersigned knowledge that he/she is voluntarily participating in an exercise/fitness activity and the use of exercise equipment and machinery. I agree that there is inherent risk in any such activity and I agree to release Results Therapy and Fitness, its officers, agents, representatives, and employees from any and all liability, damages, or expense which I have or may have against Results Therapy and Fitness arising from or relating to any accident or injury I may sustain while engaging in this activity.

I further understand and have been informed of the need for a physician’s approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been recommended that I have at least yearly physician examinations and consultations with my physician as to physical activity, exercise, and the use of exercise and training equipment. I acknowledge that I have either had a physical examination and have been giving my physician’s permission to participate, or that I have decided to participate in this activity and use of equipment and machinery without approval of my physician. I agree to assume all responsibility for my participation and utilization of equipment and machinery in my activities.