HEALTHY TEAM

FORM IV – INFORMED CONSENT FOR FITNESS TESTING

Name __________________________________________________________________
                                                                 (Please Print)

The purpose of the fitness testing program is to assess cardiorespiratory fitness and body composition. All participants in the Healthy Team event are required to participate in both an initial and final screening. Fitness testing consists of blood pressure, weight, measurement of percent body fat, blood cholesterol screening and a bench step-test, consisting of stepping up and down on a bench to determine cardiovascular (heart) fitness. Body composition is analyzed by taking several skinfold measures to calculate percentage of body fat.

In signing this consent form, I affirm that I have read this form in its entirety and that I understand the description of the tests and their components. My questions regarding the fitness testing program have been answered to my satisfaction. However, because a medical clearance must be obtained prior to my participation in the fitness testing program, I agree to consult my physician and obtain written permission before beginning any fitness tests.

I further agree to assume the risk of such testing and hold harmless the Valley United Way/Valley YMCA/Griffin Health Services/Griffin Hospital and its staff members, sponsors, and Corporate Cup Committee conducting such testing from any and all claims, suits, losses or related causes of action for damages including, but not limited to, such claims that may result from my injury or death, accidental or otherwise, during, or arising in any way, from the testing program.

_________________________________________            ________________________
                       (Signature of participant)                                                (Date)

HEALTHY TEAM PHYSICIAN CONSENT

___________________________________ is under my medical care. He/She is in good health and could benefit from a mild to moderate program of exercise and (if necessary) weight loss. He/She has no medical conditions which contraindicate this type of program.

Date_________________________________________

Signature _____________________________________

Printed Physician’s Name________________________________________________

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