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What form of exercise have you participated routinely within the last 6 months? CHECK ALL THAT APPLY

Informed Consent/Liability Waiver:

I understand the potential risks involved in participating in a rigorous physical exercise program.

I assume the responsibility and risks as explained to me. I understand that participating in an exercise program may include, but not be limited to, serious bodily injury, heart attack, stroke, or even death.

I consent voluntarily to participate in an exercise program based on the information provided to me.


I, Certify and advise that, Diana Kalivas, Diana K Fitness LLC, has advised me prior to my commencement of participation in cardiovascular and resistance training programs that such participation could result in physical injury.

That I freely and knowingly assume the risk in such programs, and I hereby waive any right, claim, or cause of action against Diana Kalivas (and any location she teaches ex: Wicked Loft/any venue) and release her and/or her company from any liability for any injury, cost, damage expense or claim, which I or anyone on my behalf might incur as a direct or indirect result of my participation in this cardiovascular and resistance-training program.

That I have read this Liability Waiver form, understand and agree with each of the foregoing points.

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© 2013 Diana K Fitness

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