Consent Form - Exercise Participation

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INFORMED CONSENT FORM

EXERCISE PARTICIPATION

PARTICIPANT INFORMATION

Participant's Full NameYour Name

Emaila valid email

Emergency Contact NameEmergency Contact Phone

Emergency Contact PhoneEmergency Contact Phone

I desire to engage voluntarily in the group exercise/fitness program sponsored by Physiomobility Health Group. I understand that the activities may be strenuous, and may require me to do body movement that I am not familiar with in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my session. Should any unusual symptoms occur, I will cease my participation. In signing this consent form, I affirm that I have read, accept and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with exercise/fitness programs and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the exercise/ fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities.

AGREEMENT AND WAIVER / RELEASE OF LIABILITY for Physiomobility Health Group and all its subsidiaries, CF Shops at Don Mills and CF Cadillac Fairview Corporation In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns to:

1. Waive, release and discharge from any and all liability to any appointed instructor, or other students for my death, disability, personal injury, or actions of any kind which may hereafter accrue to me in activities related to my participation in the sessions.

2. Indemnify and hold harmless Physiomobility Health Group and any of their subsidiaries and instructors as well as CF Shops at Don Mills and CF Cadillac Fairview Corporation, from any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation in this activity. Therefore, intending to be bound and as a condition of being allowed to participate in the fitness class, have freely signed this waiver on the date indicated.

SIGN & SUBMIT

by Electronic Signature

By signing this form, I acknowledge that I have read and fully understand this consent form. Additionally I confirm that I am 17 years or older and the provided email can be used for communication by Physiombility for announcements and newsletters.

By typing my name (the participant) below, I am electronically signing this form and consent for exercise participation.

Participant's Full Name

Date (dd/mm/yy)